I wasn’t sure what to throttle my readers with this am to go along with their jolt of coffee, and then Bernadette re tweeted the great article by Sandeep Jauhar, “The decline of the physical exam in Modern Medicine.”
It got me thinking that plain old horse sense and a good exam, can make a huge impact on improving care, and result in reduced cost of care first to the patient and subsequently to society.
In the trenches, my patients aren’t terribly well off, not unlike most of the rest of us, so I have always made it a point to prescribe generics. Two main reasons for this, saves my nurse from the God forsaken job of sitting idly by on the phone to get approval, but more importantly helps my patient stomach the cost of care.
Similar with just doing a good exam, AFTER taking a good history.
Our local hospital has enough fancy waterfalls, and huge windows, and trying to order an ultrasound or CT some days may take awhile, but more importantly, the testing, as this article point out, comes after a reasonable assessment is completed, and if necessary should then be ordered, if it can be justified.
Now lets shift gears a bit, and take the #ProjectedEHR, groans and moans, I know.
However, in my mind it is the same rational approach, you do not make doctors do all these extra steps with illogical clicks and clacks to improve care.
You integrate the EHR in a meaningful way, display, teach, learn together from the information at hand between the doctor and patient to impact, change and modify behavior. The improved care will then follow, not unlike ordering a C-spine MRI, confirming the herniated disc supported by the history and physical.
I think we are doing some of this backwards, such as ordering tests on a fishing expedition as this article points out.
I think the intention of Meaningful use is good, but it is a backwards approach of doing things.
Bernadette, I blame you for this caustic display of words muddled together, but thank you.