Med students – I’m not sure how you are learning in your H&P courses during preclinical years. I don’t know how you chart during 3rd and 4th year rotations – both in and outpatient. There have been many advances in electronic records since I began clinicals in 2006. I must say that I still choose paper over rock or EHR for myriad reasons.
1. When I had to round on patients – I knew their labs and their meds
I was encouraged by residents and attendings to find the MAR (med administration record) on the nurse med cart. In the margin of the patient progress note, I listed the meds. It offered me a chance to banter with the nursing staff to see how patients tolerated meds or if a Med was missing (i would look like a rock star to my attending if I found a med that was missing and needed to be ordered. Residents taught me how to write orders that they then co-signed.
2. Writing labs in fishbone format
I remember writing out the H/H , the BMP and other labs. I KNEW whose potassium was low and what it was. I KNEW the glucose, I KNEW the A1c. “Read, write, recite on rounds” was the mantra. When we went to full EHR and EHR notes, by 3rd year of IM residency I noticed I would often overlook a slightly low potassium.
I didn’t have to know the med list because I clicked “rounding report” and it printed the labs and meds for me. Yes, it made me lazy.
3. Writing out a full H&P – with differential diagnoses – and having it reviewed by teaching attendings was very beneficial
I learned the proper documentation to capture a patients story, what elements were needed for billing/coding, and how to share my thought process and elucidate a cohesive plan for attacking my differentials.
4. I didn’t get carpal tunnel from click click clicking the mouse
I could spend more time with patients because I had to read their chart and memorize what I could. I walked into their room and engaged them not only as patients but also as fellow human beings. I returned to the paper chart to document my findings. I wasn’t hurried to go and type until my fingers went numb.
5. Paper charts were localized
The racks were usually in nursing stations. At times I needed the chart from the case managers or speech therapists for example. This allowed me to interact with them and have dialogue about their recommendations for patients. I learned so much from these encounters beyond the medical conditions. I learned what went into discharge planning, etc.
It’s sad now. Everyone finds a computer and hides to document just like families out at restaurants glued to their smart phones at the table. The interaction is not improving among staff.
I had much more interaction with hospital staff before EHR. Not to say EHRs are not necessary, but learning during a transition period in medicine has shown me both sides.
Students – make time to discuss cases with nurses, therapists, and case managers to name a few. Not to sound like Ron Burgundy but “Medical Team Assemble!!!!”
Paper and patients beat rock and EHR any day in this young physician’s opinion.
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