Rock, Paper…eh.. EMR – patient documentation in 2017


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.

First week on night float as an Intern with my senior resident Dr. Amith Skandhan (June 2008)


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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Categories: General Inspiration, My experiences in Medicine, Random Thoughts

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1 reply

  1. Should be required reading for all who look down their noses at the personal interactions you describe, instead going with shiny new technology!

    Love to you and the lovely ladies in your life:)

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