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07/25/08
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April 5,
2005 The medical record used to serve two main purposes. It was a record of what had been done and the patient's response to it. A main component of it was communication between the different health care providers so that things didn't get missed or repeated. I remember as a young nurse being put in charge of the "cardex". All of the doctor's orders were transferred from the charts to the cardex in pencil each time the doctor's did their "rounds" or whenever a nurse called for a telephone order. We would erase old orders and pencil in the new ones. The nurses would come to the cardex to see what lab tests had been ordered, diet changes and everything else. As a nurse on the floor, I relied on the cardex to maintain the care of my patients and the one responsible for the cardex had to be both accurate and honest. Then, after we had carried out the orders, we initialed the cardex, then wrote in the nurse's notes about what had been done and how the patient responded. It was that simple, and we spent at least 90% of our time actually with the patients. An RN actually gave patients back rubs. Then came Medicare and various other attempts by the government to "regulate" medicine. The medical record went almost overnight from a communication and memory tool to a complex attempt to justify every action. As the lawsuit insanity heated up, it became ever more important to document every little item in great detail in the hopes that a jury wouldn't just close their eyes and vote a windfall on the so called plaintiff, regardless of the documentation. It also became the only basis on which the medical services were paid. Year after year, the whole process got more and more complicated, with endless repetition and duplication. It doesn't take a rocket scientist to understand that the more complex something gets, the greater the chance for error and the less time there is to spend in the primary occupation of caring for people. Just as a small example, consider the "care plan". In most medical settings, this is a complex set of pages for each patient that outlines in graphic detail each item required in the care of the patient, no matter how small or common. Nothing is a "given", and as things change, this massive document must be changed as well. Never mind that nobody actually uses it for anything remotely connected to the actual care of the patients. The doctor's orders are still the only real "care plan", along with the usual and ordinary actions required to carry them out. Nurses certainly don't have the time to consult this thing often, and yet each nurse's note is supposed to mirror that "plan", chapter and verse. The current "medical record" is a hopeless mess of thousands of pieces of paper, like a giant jigsaw puzzle cut out in a blender. It is almost impossible for them to actually all fit perfectly together and the only answer the government has for the problem is to ever increase the complexity and require more and more pieces of paper that must all say the same things!! The number of people who must be hired to manage all that paper outnumber the actual nursing staff considerably. It is also one of the reasons that medical costs have skyrocketed. This, and the lawsuits, are the major problems driving both the nursing and doctor shortage. Health professionals chose medical careers to take care of people, not generate endless handwritten confetti to suit bureaucrats. A full 50% or worse of the doctor and nurse's time is now spent satisfying - or trying to satisfy - this paper monster. The consequences of not pleasing the arbitrary and often capricious bureaucrats who oversee things is denial of payment at best and loss of "license", with actual jail time possible! That's a powerful incentive to join the plumber's union or open a real estate office, and many former nurses and other healthcare professionals have already done so. Most recently these busybody bureaucrats decided that the age old tradition of confidentiality and respect for the privacy of patients wasn't good enough. Even though government itself is immune from any of the provisions - bureaucrats can violate your privacy any time they feel like it - they set up an elaborate web of rules and regulations that seriously hamper the ability of medical professionals to share information or to keep families informed. HIPPA (the Health Insurance Portability and Accountability Act) has done as much or more damage to medicine as all the rest of the bureaucracy to date, and we've only just begun to see the affects. So, guess who suffers most from all this? Of course, the patients. It also damages those very professionals who want nothing more than to provide you with good health care. Think of that next time you read that the government is "protecting" you. Better yet, ask your plumber or real estate agent. I suspect they may know better. No purpose
is served that helps patients or their caregivers, just job security for
bureaucrats. Now, don't you feel safer?
Related articles: Medicare's
Origin: The Economics and Politics of Dependency Medicare
Seen Insolvent by 2019 Americans
for Free Choice in Medicine (AFCM) is a national non-profit, non-partisan
educational organization. Heartland
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