HIV and ID Observations

January 2nd, 2019

How Did Our Medical Notes Become So Useless?

Among the many complaints about electronic medical records (EMRs), the death of the useful medical note ranks very high. Notes are too long, too complex, and filled with unhelpful words. It’s often impossible to glean what the clinician thinks is going on, or what’s planned. Ever get a note from an urgent care clinic on a patient […]

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December 6th, 2015

Do Electronic Health Records Make You a Better (or Worse) Clinician?

Earlier this week, JAMA Internal Medicine published a study entitled, “Level of Computer Use in Clinical Encounters Associated with Patient Satisfaction”. A more descriptive title would have been “More Computer Use in Clinical Encounters Associated with Reduced Patient Satisfaction”, as here’s the take home point: High computer use by clinicians in safety-net clinics was associated with lower patient satisfaction […]

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September 20th, 2015

EHR and Drug Prescribing Warnings: The Good, the Bad, the Ugly

Part 1. The Good. Recently, an ENT colleague (fictionally named “Clint” below), sent me two emails triggered by drug-drug interaction warnings he received while seeing HIV patients. Here’s #1: Hey Paul, I saw Mark C yesterday for hoarseness, and his exam was negative. Thought we’d try a PPI for reflux, but when I wrote the script, I […]

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August 9th, 2015

The Pain — and Potential Power — of Electronic Health Records in One Little Anecdote

Here’s a scintillating series of events that happened recently on our inpatient consult service: Reason for consult: “Treatment of UTI in a 26-year-old pregnant woman with multiple allergies.” Culture result:  Group B strep, resistant to clindamycin and nitrofurantoin. She’s been on the latter. Patient’s allergies as listed on her chart:  Penicillins, cephalosporins, sulfonamides. Plan per OB service: […]

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February 5th, 2014

Electronic Medical Records, Eye Contact — and Dogs

A few thoughts on the importance of eye contact during patient care, no doubt inspired by my puppy’s first birthday, and his insistent and adoring (at least that’s how I see it) gaze: Long piece in the New York Review of Books — all doctors subscribe, of course — by Arnold (Bud) Relman, describing his experience […]

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