It’s never supposed to happen of course. But it happened today: the computer froze and could not be resurrected – a brief interlude to the daily clinic routine.
The reactions are predictable:
"Damn it. What the hell’s wrong?… Let’s try to re-boot…. (a long pause) … A switch turned off, then on… Come on, baby!!!!!… Shoot, still nothing!"
Clicks upon clicks, then an embarrassed look on your face. "Sorry, Ms. Jones. Usually this system works great…" !@#$^%&$)#! "Seriously, um, …. just a moment." The doctors walked out of the exam room.
"Hey, you guys having the same problem I’m having?"
"Yeah, our terminal’s not responding either. I think we’ve got a Code Green."
(Editor’s note: I know what you’re thinking… don’t go there…)
"How about a piece of paper? Oh, and a pen? Anybody got a pen? Damn, where are the pharmaceutical reps when you need them?" The office manager sprung to action: "I’ll get out the Code Green box!" You figure there’s a plan, but seriously, this is it? Some archaic progress notes appear, the medical assistant found a pen, then some interesting order forms that you’ve never seen before appear. "Dang, I have to fill those out?" You think, "How will the lab and X-ray get these?" "Do we call the orders in? Maybe someone walks them down. Hey, maybe the patient can help out!" After all, the only way out is through this mess. But it didn’t stop there:
"What about that prescription – anybody got a prescription pad?"
"No, got rid of those a long time ago. We’re electronic now, remember? Can’t use them any more."
"No? Shoot, what do we do?"
"Try calling it in," someone shouts from down the hall.
"Why didn’t I think of that? Good thing I have my handy, dandy cell phone!" Google is consulted, the number for the patient’s preferred pharmacy appears, the call is made and order placed on the recorder. The patient is impressed: "Thanks, doc! That was nice of you to call it in for me." We shook hands. Mission accomplished.
Sorry, no ‘After Visit Summary" was given to the patient, no medication list was printed. No copy of the note was sent back to the referring, no orders to verify, no orders pending, no quality assurance pay-for-performance measures were completed, no billing codes entered and as a result, no bill instantly submitted. Surely our quality measures took a hit.
Instead there was just a handshake, a look in the eye, and an "Appreciate your patience" message tacitly transmitted. In return: "No problem, doctor, I appreciate your help with this."
Suddenly it dawned on me: "Damn, it’s like the good old days!"
Oh sure, it took a little longer and I’m sure my notes were illegible to anyone but the most seasoned of veteran nurses. Whether I get paid for these visits remains to be seen, too. But this once, for a tiny moment of time, I experienced a blast from the past that proved, beyond a shadow of a doubt, that the computers are about the computers, rules, protocols and billing while health care was still about the doctor and the patient.
Like turning off the TV and computer at home, it was a brief but beautiful respite from the daily monotony of a thousand keyboard clicks. Sure, the transition from electronic medical record to a paper-based one was abrupt and challenging. But I found patients responded to our efforts with much more appreciation, not just an air of expectation. And despite the challenges of the day, it was good to know that I can still be a doctor that thinks out of the box and not just a clerical secretary.
-Wes
