Old School

My medical assistant took a week off to cruise the Caribbean. She's my peripheral brain in the clinic, telling me where to be and what's up next. While she was away I ended up at our remote clinic, about 20 miles from homebase, without my laptop computer. That would be the one with voice recognition for all my office notes. The one with all my electronic charts for the day. The laptop with all the capacity I need to see patients for the day. Fortunately for me, I have great staff and had someone available to run my computer out to me.

In the half-hour I went without my electronic medical record (EMR or EHR in all the media and political discussions) I had the opportunity to re-visit the "good ol' days."  By that I mean the really old days. In that time I did what we always used to do: jotted down a few hand written notes for each patient. Within a few patient visits I realized I was able to record everything I actually needed to know about the patient encounter in 1 or 2 shorthand lines of notes.  It wasn't enough information to satisfy an insurance payor, It wasn't enough information to satisfy a hungry lawyer, It wasn't enough information for Medicare reimbursement.  But it was all the information I needed to know what happened, what was wrong, and what needed to be done. One or two pencil-sketched, abbreviation strewn lines requiring no more paper or space than that between the patient entries on my schedule, and I was able to record the who what how and what's next of patient care.

My experience reminded me of a long deceased uncle who was a dentist in Portland, Oregon for probably close to 50 years; I'm pretty sure into his eighties. His office was a relic even back in the days before relics. He worked alone. He had a small waiting room. No TV, no aquarium, just old magazines. Through the door was his dental chair, antique pulley driven drill, his phone, and his appointment book. Period. It was like going to the barber. I don't have any recollection of any record keeping and I'd be surprised if there was any record keeping. He didn't need it. Neither did anyone else.

I can state with confidence the simple note taking I did the other day allowed me to collect all the information I needed to initiate or continue competent care for the six or so patients I saw before my laptop arrived. My method would never ever meet the requirements of modern practice what with Medicare, Medicaid, private insurance, auto insurers, workers compensation, and malpractice concerns. But the fact remains, my notes were enough for me to provide care.

And we wonder how healthcare got so expensive.