Dear Patient: tell me about yourself…again

Posted in Susan Fekety on December 11th, 2008
Unless otherwise noted, © Copyright 2008 by Susan Fekety. All Rights Reserved.

One of my dear relatives has been in and out of the hospital twice recently — she’s home now, and doing well. The family was lucky enough to be set up with a Visiting Nurse to help her transition back, and the first visit was today. Apparently, an abundant amount of time was spent with the nurse taking a medical history.

“Any problems with your breathing?” She asked. First off, this confused my relative, who answered with a “No…” (as in “No, not now that I have medications I take for my chronic lung disease and I’ve quit smoking.”) So there was a flirtation with miscommunication there. Fortunately, this was straightened out by a younger companion more willing to be, um, direct. (Thank goodness she was there. Imagine the potential confusion. Hmmm…)
But more important (well, not really more important, but the “bigger picture issue not to be missed”) is why in the heck does a person who has been going to the same doctor at the same hospital for 40 “fricking” years need to give a NEW HISTORY to every care provider she sees? Like, don’t we have the technology to convey that information to one another — at the very least within the same system? Computers? Photocopiers? Hello?

If she moved to another state, I could see it, but this particular health system has known this woman for a really long time!

This got me thinking. In modern medical settings, with each encounter you get queried as though you’ve never seen a clinician before, as though you’ve been living in the woods or something. Does each caregiver think that perhaps THEY will ask you the questions so BRILLIANTLY that a “Really Important Fact” will be revealed that nobody else has managed to elicit? Or what?

I remember when I had my gallbladder out a few years ago I gave my medical history/allergies/family history about five times to different people. Let alone my address, phone number, occupation, bla bla bla.

“Don’t you people TALK to one another?” I wanted to cry out! I decided I was probably overreacting because of stress, so I let it go — and here it is now again, saved up.

It’s a huge waste of human energy, this taking and taking and taking of the history. And particularly with the elderly, who get tired, lose track of time, and forget.

Of course getting someone’s history is important — but you don’t have to do it again and again. As a clinician, I am happy to read someone else’s well-executed medical history and ask a couple judicious clarifying questions, or ask someone to expand on a piece of information, or to tell me about a particular health-related experience he or she has had.

Regarding my relative’s multiple admissions through the Emergency Room, her companion said it was all she could do to make sure that each of the various caregivers got the story straight. She now routinely brings a handful of copies of updated meds lists to every doctor visit and gives them away. Staff people are thrilled to get their own copies so they don’t have to write it all down. Folks, this is not rocket science.

Efficiency initiatives in health care often focus on EMR (electronic medical records), usually costing thousands of dollars and putting a laptop computer between you and your practitioner. Gotta say, the ones I’ve seen are cumbersome and crazy and generate huge wasteful piles of paper if heaven forbid you need to send information to someone NOT on that particular computer system or using the same EMR brand. They appear to be geared primarily towards ensuring that visits are documented in the particular format which is required by the unbelievably arcane health insurance billing system (oh, another rant there!) and not towards optimizing patient care for either the patient or the clinician.

Seriously, couldn’t we just start with a simple shell (or kernel, I guess) containing the basic stuff about each of us? Firewall protected, all that.

Maybe on one of those plug-in memory chip things, to carry in my wallet or put on my key ring. To my mind, that would be a terrific first step towards streamlining these cumbersome encounters. And if you’d like, I’ll tell you all that over again, next time you ask.