At Johns Hopkins, we now have a brand new electronic medical record (from the EPIC quasi-monopoly). I am liking it more than I thought I would. But one of the downsides of computer record-keeping is that free form narrative is trapped in forms and checkboxes - which come to think of it is no innovation of the computer age, merely something facilitated by it. Thus the patient's story about why they came to the doctor is shaved down to one phrase or sentence which fits into the "Chief Complaint" box in EPIC. Of course, even that sort of limited reason can be of interest. For example, a recent study from the Mayo Clinic, too recent to include in my book, counted up the non-acute (i.e., chronic, or long-standing) reasons behind the visits of about 150,000 thousand patients. The most common problems were joint issues, skin complaints, "disorders of lipid metabolism," and upper respiratory infections. Fascinating: how many of the patients with "lipid disorders" came with numbers out of the so-called "range of normal" which they thought needed treatment only because a drug exists to do so? How many complaints could be dealt with over the phone, or by email? How many lipid panels are done unnecessarily?
On the other hand, often the reason-for-visit expressed in a phrase or two often doesn't get down to the nub of what brings one of us in to see our doctor. Often we are sidewinded by pain, knocked out of breath by a death in the family, beset by fatigue and futility, or with too many problems to count. Sometimes I can't limit someone's complaints to just two or three because they have a dozen or more.
This is just to say that counting the reason for a visit is important, and useful. But sometimes we can also refrain to count and just let the story be told without any interference. That could be a visit more narrative than EPIC.
On the other hand, often the reason-for-visit expressed in a phrase or two often doesn't get down to the nub of what brings one of us in to see our doctor. Often we are sidewinded by pain, knocked out of breath by a death in the family, beset by fatigue and futility, or with too many problems to count. Sometimes I can't limit someone's complaints to just two or three because they have a dozen or more.
This is just to say that counting the reason for a visit is important, and useful. But sometimes we can also refrain to count and just let the story be told without any interference. That could be a visit more narrative than EPIC.
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