The other day during a practice session, when I opened a file for a patient that I was about to start seeing, I noticed that the electronic health record (EHR) had suddenly tagged his file with something new. Under “Gender Identity,” he said, “The patient chose not to disclose. “
“It’s strange,” I thought. “I wonder what was going on here that led to this change.” The last time I saw the patient there was an actual sex choice listed (and he had listed that choice for them to the best of my recollection since we started using this system over 14 years old).
When I walked into the room I asked my patient, who I have looked after for over 20 years, if anyone had asked this question and maybe he had decided he didn’t want it all. just not that that information was on their file, or maybe even that something had changed in the way they wanted to be identified. My patient looked at me like I was a little crazy and said he had no idea what I was talking about. Obviously, someone toggled something somewhere during part of the recording to change the patient’s actual gender to this non-binding response, and it made me realize that there are so many places where we have to make so many choices to provide our patients with the care they need that we are all totally overwhelmed.
I was reminded of the mandate that every patient who comes to the emergency room, regardless of why they are there, should be offered an HIV test. While this makes sense from an epidemiological point of view – it is a way to ensure that more tests and more diagnoses are made – more often than not in the graph we see a notation that says “the patient refused HIV testing today “. I often wonder, like so many things that we just click to go through them, do we really ask, or do we just fill in the box on the form that says, “Patient doesn’t want to be tested”? We’ve all done it, each time with a little pang of heart.
Like a lot of these things, I think we should have the capacity and the authority to just say, “It’s not really relevant today; I have more important things that I need to take care of in order to safely care for this patient. they need. ”In more and more places where we try to care for patients, whether it’s having to enter a pain score, reconcile a medication list, fill out Health care screening questionnaires or updating health care maintenance items, the number of tasks has become so heavy that the very task of completing each visit has become exhausting.
I’m not saying there’s nothing good in having frequent reminders and making sure we don’t let things fall through the cracks, but there has got to be a better time, and a better time. place, and better resources we can devote to these issues to help ensure they’re done in the right place at the right time in a way that makes sense. Never performing these tasks also puts our patients at risk, and we should never be allowed to permanently postpone most of these tasks, perhaps unless we and our patients decide it makes the most sense to them.
Quite recently, our patients have acquired the ability to go through their medication list and mark medications for withdrawal, and list the reasons for them. They can say “I am no longer taking this medicine”, “I have finished this treatment”, “I have never taken this medicine” or choose from a number of other choices. This type of active engagement on the part of our patients empowers them and allows us to quickly review and update their medication list with confidence, so that we can be okay with what we think they are taking. and document better truth.
I think we should be able to extend these features and let patients say if they want to change their gender identity on their chart today, if they want to tell us who their healthcare proxy is and what their end of life choice. They should be able to tell us that they have had a previous flu shot or had their mammogram; they should be able to actively participate in the electronic health record and make changes that we can all agree on. That way, I think we’re more likely to come to a place where this recording reflects a more precise version of the truth, rather than something where we click boxes to take ourselves through hard stops, or copy. – stick our way through to get to some sort of safe place at the end where we don’t really know what’s going on.
What if during today’s visit we decide not to do an HIV test because the patient is there with a sprained ankle and it might not be the right time or place? , or we have no reason to believe that her gender identity has changed in the past 95 years, perhaps we can postpone these elements to a later date, or relegate them, with everyone’s consent, to a position Permanent “out of service”, unless someone changes their mind at some point in the future.
The more we can clean things up, make them more efficient, make sure that the systems don’t get in the way of taking care of patients, the better our patients will be and the better we will all be interacting with them in so many different settings in the world. health system will end up.
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Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage today, follows what is happening in the world of primary care medicine from the point of view of one’s own practice.