Search Journal-type in search term and press enter
In Memoriam
Social Media-Follow Southwest Journal of Pulmonary and Critical Care on Facebook and Twitter

Editorials

Last 50 Editorials

(Click on title to be directed to posting, most recent listed first)

Not-For-Profit Price Gouging
Some Clinics Are More Equal than Others
Blue Shield of California Announces Help for Independent Doctors-A
   Warning
Medicare for All-Good Idea or Political Death?
What Will Happen with the Generic Drug Companies’ Lawsuit: Lessons from
   the Tobacco Settlement
The Implications of Increasing Physician Hospital Employment
More Medical Science and Less Advertising
The Need for Improved ICU Severity Scoring
A Labor Day Warning
Keep Your Politics Out of My Practice
The Highest Paid Clerk
The VA Mission Act: Funding to Fail?
What the Supreme Court Ruling on Binding Arbitration May Mean to
   Healthcare 
Kiss Up, Kick Down in Medicine 
What Does Shulkin’s Firing Mean for the VA? 
Guns, Suicide, COPD and Sleep
The Dangerous Airway: Reframing Airway Management in the Critically Ill 
   Linking Performance Incentives to Ethical Practice 
Brenda Fitzgerald, Conflict of Interest and Physician Leadership 
Seven Words You Can Never Say at HHS
Equitable Peer Review and the National Practitioner Data Bank 
Fake News in Healthcare 
Beware the Obsequious Physician Executive (OPIE) but Embrace Dyad
   Leadership 
Disclosures for All 
Saving Lives or Saving Dollars: The Trump Administration Rescinds Plans to
   Require Sleep Apnea Testing in Commercial Transportation Operators
The Unspoken Challenges to the Profession of Medicine
EMR Fines Test Trump Administration’s Opposition to Bureaucracy 
Breaking the Guidelines for Better Care 
Worst Places to Practice Medicine 
Pain Scales and the Opioid Crisis 
In Defense of Eminence-Based Medicine 
Screening for Obstructive Sleep Apnea in the Transportation Industry—
   The Time is Now 
Mitigating the “Life-Sucking” Power of the Electronic Health Record 
Has the VA Become a White Elephant? 
The Most Influential People in Healthcare 
Remembering the 100,000 Lives Campaign 
The Evil That Men Do-An Open Letter to President Obama 
Using the EMR for Better Patient Care 
State of the VA
Kaiser Plans to Open "New" Medical School 
CMS Penalizes 758 Hospitals For Safety Incidents 
Honoring Our Nation's Veterans 
Capture Market Share, Raise Prices 
Guns and Sleep 
Is It Time for a National Tort Reform? 
Time for the VA to Clean Up Its Act 
Eliminating Mistakes In Managing Coccidioidomycosis 
A Tale of Two News Reports 
The Hands of a Healer 
The Fabulous Fours! Annual Report from the Editor 
A Veterans Day Editorial: Change at the VA? 

 

For complete editorial listings click here.

The Southwest Journal of Pulmonary and Critical Care welcomes submission of editorials on journal content or issues relevant to the pulmonary, critical care or sleep medicine.

---------------------------------------------------------------------------------------------

Entries in medical (2)

Tuesday
May162017

Worst Places to Practice Medicine 

Medscape periodically publishes a “Best” and “Worst” places to practice medicine (1). We were struck by this year’s list because three of the five worst places to practice medicine are in the Southwest (Table 1).

Table 1. Medscape’s “worst” places to practice medicine.

  1. New Orleans, Louisiana
  2. Phoenix, Arizona
  3. Las Vegas, Nevada
  4. Albuquerque, New Mexico
  5. Tulsa, Oklahoma

While Minneapolis rated the best place to practice, only 2 cities from the Southwest made the top 25 “Best” list-Salt Lake City at 13th and Colorado Springs at 24th. Most of the top 25 are from the Midwest or Northeast. None from California made the best places list and only the only Southern location was Virginia Beach, Virginia. 

Rankings resulted from the combination of twelve 50-state rankings: medical board actions per doctor; malpractice lawsuits per doctor; office-based primary care physicians per population; physician income; employer-based insurance rate per population; insurance coverage per population; reported rates of well-being of the general population; violent crime rates; participation in wildlife-related recreation; divorce rates; use of family-friendly amenities; and cost of living.

Phoenix, Las Vegas and Albuquerque were singled out for high rates of uninsured patients. Phoenix was also singled out for its moderately high malpractice suit rate.

Before everyone in the Southwest decides to move, these ratings may be meaningless, much like hospital rankings (2). Furthermore, there seems little that physicians can do to improve the situation based on the selected metrics. What can be done is to continue our efforts through our professional organizations to educate the public and their elected representatives that job satisfaction is necessary to recruit and retain physicians, as well as nurses and other health care professionals. A healthcare organization without these well-educated and caring people lacks quality and attempts to substitute substandard care is much like trying to substitute a Yugo for a Mercedes.

Richard A. Robbins, MD

Editor, SWJPCC

References

  1. Page L. Best places to practice to avoid burnout. Medscape. May 10, 2017. Available at: http://www.medscape.com/viewarticle/879573 (accessed 5/16/17).
  2. Robbins RA, Gerkin RD. A comparison between hospital rankings and outcomes data. Southwest J Pulm Crit Care. 2013;7(3):196-203. [CrossRef] 

Cite as: Robbins RA. Worst places to practice medicine. Southwest J Pulm Crit Care. 2017;14(5):236-7. doi: https://doi.org/10.13175/swjpcc060-17 PDF 

Monday
Nov282016

Mitigating the “Life-Sucking” Power of the Electronic Health Record 

An article in PulmCCM discussed “life-sucking” electronic health care records (EHR) (1). It is in turn based on an article in the Annals of Internal Medicine on the work time spent by physicians (2). The latter, funded by the American Medical Association, observed 57 physicians in internal medicine, family medicine, cardiology, and orthopedics over hundreds of hours. The study revealed that physicians spend almost two hours working on their electronic health record for every one hour of face-to-face patient time. Interestingly, physicians who used a documentation assistant or dictation spent more time with patients (31 and 44%) compared to those with no documentation support (23%).

The PulmCCM goes on to list some of the reasons that the EHR requires so much time:

  • The best and brightest minds in software design don't go to work for Epic, Cerner, Allscripts, and whoever the other ones are.
  • There's a high barrier to entry for competition now that most major health systems have implemented the big-name systems.
  • The vendors can't easily improve the front-end design's user-friendliness (like web pages and consumer software have) because it rests on clunky, proprietary frameworks built in the 1990s and which can't be substantially changed for stability reasons. Think Microsoft Office, but way worse.
  • Software designers are congenitally incapable of accepting the reality that a user would be better off the less they use the product, and designing it that way. They think their EHR is super cool, and can't fathom that it actually sucks to use.

Let me add another possibility. Those who demand implementation of the EHR see documentation as being most important because of the bottom line. It if comes at the price of physician efficiency so be it-as long as it does not hurt payment. Physicians are not paid for the required increased documentation much of which is unnecessary, redundant and, in some cases, downright silly (3). Furthermore, the concept that this improves patient outcomes largely seems to be a myth (4). Those manuscripts that report improved “quality” of care usually have examined meaningless surrogate metrics that often have little or even inverse relationships with patient outcomes (3). For example, high patient satisfaction seems to come at the price of increased mortality (5).

What is the solution-charge for the time. As it now stands, there is no downside to demanding pointless documentation. Third party payers can deny payment when something like the rarely beneficial family history is omitted. There should be a charge for seeing and caring for the patient and another “documentation fee” that is based on time. That would mean that a 20 minute office call would not be billed at 20 minutes but at the 1 hour of physician time the visit really consumes. Those physicians who use a documentation assistant or dictation can pay for these services by seeing more patients. Only in this way can the trend of wasting physicians’ most precious resource, their time, be mitigated.

Richard A. Robbins, MD*

Editor, SWJPCC

References

  1. PulmCCM. Life-sucking power of electronic health records measured, reported, lamented. November 25, 2016. Available at: http://pulmccm.org/main/2016/outpatient-pulmonology-review/life-sucking-power-electronic-health-records-measured-reported-lamented/ (accessed 11/28/16).
  2. Sinsky C, Colligan L, Li L, et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med. 2016 Sep 6. [Epub ahead of print] [CrossRef] [PubMed]
  3. Robbins RA. Brief review: dangers of the electronic medical record. Southwest J Pulm Crit Care. 2015;10(4):184-9. [CrossRef]
  4. Yanamadala S, Morrison D, Curtin C, McDonald K, Hernandez-Boussard T. Electronic health records and quality of care: an observational study modeling impact on mortality, readmissions, and complications. Medicine (Baltimore). 2016 May;95(19):e3332. [CrossRef] [PubMed]
  5. Fenton JJ, Jerant AF, Bertakis KD, Franks P. The cost of satisfaction: a national study of patient satisfaction, health care utilization, expenditures, and mortality. Arch Intern Med 2012;172:405-11. [CrossRef] [PubMed]

*The views expressed are those of the author and do not reflect the views of the Arizona, New Mexico, Colorado or California Thoracic Societies or the Mayo Clinic.

Cite as: Robbins RA. Mitigating the “life-sucking” power of the electronic health record. Southwest J Pulm Crit Care. 2016;13(5):255-6. doi: https://doi.org/10.13175/swjpcc125-16 PDF