Skip to main content

Documentation: another reason for radical tort reform

In medicine we always seem to use a word with many syllables where a couple of words that people can actually understand would do. Thus the word "documentation". In the practice of medicine, since I have been practicing it, we spend lots of time writing stuff down.  The amount of this writing or typing or dictating or computer point and clicking that we do has gradually increased, and is now eating up the time that we could use to do other important things, like take care of patients, for instance.

In my own practice I spend over half of my time creating some sort of record of what is going on with my patients' care.  Most of it is necessary, and if I were to reduce the time that I spent in documentation, it would be by streamlining the process, maybe by using a better computer system. Most of the words on paper or words on a screen are valid communication, though the detail in which I keep my records is primarily to satisfy insurance companies and the legal system should I be unlucky enough to be sued.

In the hospitals and the nursing homes, though, the situation has become much more dire.  One nurse I spoke to today said that she spends at least 4 hours of a 12 hour day record keeping, and of that she thinks that probably nobody reads any but a tiny fraction of it.  The nurses I work with in the intensive care unit say that anywhere from half to three quarters of their time is spent in documentation, and maybe 20% of that is ever useful. "The only one who is ever going to read this stuff is the lawyers," said one of them. In nursing homes the situation is the same, and with the ratios of staff to patients that nursing homes have, this results in hurried and inattentive care and unhappy harried staff.

I would propose that in reforming the tort system and insurance systems the whole system of documentation be revamped.  This would require the involvement of nurses, physicians and administrators to determine exactly what parts of the documentation we do actually benefit the process of taking care of patients.  Sometimes writing can be part of remembering, in the case of complex work routines. It would also require a cooperative interaction with whatever legal organization would deal with medical error and malpractice, since this will not entirely go away. If malpractice law is reformed in the way it should be, to make it a vehicle for compensation and quality improvement, we will need to have some way of tracing what happens in situations of medical injury. We will need to be able to look at the processes that lead to errors so we can change systems to work more efficiently.

Comments

Popular posts from this blog

How to make your own ultrasound gel (which is also sterile and edible and environmentally friendly) **UPDATED--NEW RECIPE**

I have been doing lots of bedside ultrasound lately and realized how useful it would be in areas far off the beaten track like Haiti, for instance. With a bedside ultrasound (mine fits in my pocket) I could diagnose heart disease, kidney and gallbladder problems, various cancers as well as lung and intestinal diseases. Then I realized that I would have to take a whole bunch of ultrasound gel with me which would mean that I would have to check luggage, which is a real pain when traveling light to a place where luggage disappears. I heard that you can use water, or spit, in a pinch, or even lotion, though oil based coupling media apparently break down the surface of the transducer. Or, of course, you can just use ultrasound gel. Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glyce...

Ivermectin for Covid--Does it work? We don't know.

  Lately there has been quite a heated controversy about whether to use ivermectin for Covid-19.  The FDA , a US federal agency responsible for providing unbiased information to protect people from harmful drugs, foods, even tobacco products, has said that there is not good evidence of ivermectin's safety and effectiveness in treating Covid 19, and that just about sums up what we truly know about ivermectin in the context of Covid. The CDC, Centers for Disease Control, a branch of the department of Health and Human Services, tasked with preventing and treating disease and injury, also recently warned  people not to use ivermectin to treat Covid outside of actual clinical trials. Certain highly qualified physicians, including ones who practice critical care medicine and manage many patients with severe Covid infections in the intensive care unit vocally support the use of ivermectin to treat Covid and have published dosing schedules and reviews of the literature supporting...

Actinic Keratoses and Carac (fluorouracil) cream: why is this so expensive?

First, a disclaimer: I don't know why Carac (0.5% flourouracil cream) is so expensive. I will speculate, though, at the very end of this blog. Sun and the skin: what happens If a person reaches a certain age, has very little pigment in her skin, and has spent lots of time in the sun, bad stuff happens. The ultraviolet radiation of the sun does all kinds of great things: it makes us happy, causes us to synthesize vitamin D which strengthens our bones and it gives us this healthy glow until we get old and wrinkled and leathery. And even that can be charming. The skin cells put up with this remarkably well for a long time, partly aided by melanin pigment which absorbs the radiation, which is why we tan and freckle, if we are fair skinned. Eventually, though, we absorb enough radiation that it injures the skin and produces cells which multiply oddly. It also damages the skin's elasticity which creates wrinkles. The cells which reproduce in odd ways peel, creating dry skin or...