From the Board: My Perspective

By Kenneth A. Liss, DO

Ironically, the request from the editorial staff for 250 to 500 words coincides with day five of our electronic records being disabled. We have been informed that a “ransomware attack” has forced our service provider to block access to our digital records in the name of privacy and security. Unable to get medication lists, labs, and radiologic data, I have been forced to look my patients in the eye when I take their history and actually show empathy rather than a pathologic obsession with completing the chart.

Obvious challenges aside, I have found it refreshing to get back to the basic tasks of being a physician. Simply, to provide concerned and compassionate care for my patients. I have found that a similar ethos applies to the weekly evaluation of our ESRD population. Required to see the dialysis patients weekly in order to maximize reimbursement, it is often difficult to discuss the same health issues repeatedly. I sometimes find that a discussion about sports, politics, or family issues is much more rewarding for myself and the patient, rather than repeated admonitions about the risks associated with hyperphosphatemia.

I have surveyed my patients on numerous occasions and most of them are of the false assumption that electronic records are immediately transferred to their other care providers once I have signed out of the encounter. They have been led to believe that digitalization of patient visits was established to improve quality rather than limit reimbursement. I am sure they would be equally surprised to understand that, for the most part, the only discernible and useful parts of an encounter is that which is free texted or dictated. This is particularly striking with the required four monthly dialysis visits when I am completely unable to follow an established patient narrative because the electronic record is indecipherable.

I won’t appeal to you to spend more time connecting with your patients. I am painfully aware that we would all like nothing more. It continues to be our main reason for going to work every day and unfortunately has become more and more difficult given our constraints. I do ask that we use our limited time more constructively so that while we are imparting our vast experience, we also understand that our patients are more than a dry weight, crit line, or maturing AV access. When I spend the next three nights trying to recreate the records that I manually scribed rather than watching the Flyers game, I will be grateful for computer viruses.