Patrick Johnson, MD is a physician in Lagrange, TX, who’s bio indicates that he is the Chief Medical Officer for Tejas Health Care and holds a medical degree from the “highly prestigious” St. George’s University School of Medicine, Grenada, West Indies. This off-shore medical school turns out over 800 graduates annually flooding the US with international grads who were generally rejected by US schools (it’s rarely the first choice of Americans).
Johnson recently penned a whiny screed decrying the woes of the modern physician saddled with electronic medical records. It starts with this gem:
I believe that it is high time that medical doctors (not “providers”) rise up and regain our rightful and long-lost place at the top of the medical hierarchy. How in the world did this happen in the first place? How did we become second-class citizens, led around by the nose and pushed around by those with half of our education, intelligence, and dedication?
His rant goes on from there with more whining, half truths an bizarre statements. In fact the answer to some of his questions are inherent in the questions themselves. For instance, what kind of massive hubris could possibly make this graduate of a third-rate, off-shore medical schools believe that he has a “rightful” place anywhere. The practice of medicine is a privilege (most certainly not a right) to participate in a governmentally sanctioned monopoly. He goes on to state that he’s twice as smart as those leading him around by the nose (I wonder if he also has wonderful hands a great brain). I’m assuming he’s self-referential here since I suffer no such leadership. But then I work in an environment where my leaders have earned their positions and they’re indeed rather smart.
But he goes on with even more whiny nonsense:
Almost none of the “innovations” happening in medicine these days come from doctors, they all come from bureaucrats and non-physician managers. They all come from outsiders who now know best. Doctors have become whipped dogs waiting passively for the next group of bureaucrats to rain down the next mumbo-jumbo solution from on high.
This time he is, in fact, correct. Most doctors are not innovative. Most doctors are like Johnson and would prefer be “worshiped” for their superior intellect and supreme doctoring skills (although most are painfully average). Doctors would rather procratinate and complain about “work-life balance”- which is usually code for “pay me more for working less.” Rather than blaming the innovators for doing what they do why doesn;t Johnson get off his off-shore medical school butt and make some meaningful contributions. An online rant about his poor lot in life is not a contribution and definitely not innovative.
He gets better:
There now is a huge emphasis on measuring the “quality” of medical care and to improve “outcomes.” I believe it is impossible to judge the quality of medical care by looking only at discreet, retrievable data points generated by an EHR.
This is the epitome of a specious argument. The push for quality has existed since the Flexner report in 1910 (but I wouldn’t expect an off-shore medical school to devote mush time to American medical history). Outcomes have been a concern since the days of Hippocrates and Maimonides. These are nothing new. The use of an electronic record simply allows data to be captured. Prior to electronic records handwritten paper records were used similarly (perhaps there were no records at all in his off-shore medical school).
But his genuinely fallacious arguments start a bit later with:
Quality starts with a relaxed, unhurried atmosphere where the doctor asks the patient about their concerns, takes a thorough history and performs an adequate physical exam. He then uses his experience and vast knowledge of anatomy, biochemistry, physiology, and pathophysiology and interprets appropriate studies to arrive at the correct diagnosis. He then must decide on the best medications, treatments, and follow-up plans. If done correctly, this all takes a good deal of time, much of which has now been stolen from us by the data-entry, box-clicking, and typing demands of the EHR.
I’ll grant that this is unvarnished opinion on his part. Quality might start in a relaxed, unhurried atmosphere. But neither of those are limited by and electronic record. In fact, I’ll bet the “unhurried atmosphere” in Johnson’s office includes follow-up visits scheduled every 17 minutes (or less). I’m quite certain that’ his doing, not the electronic record’s. Again, nothing about using an electronic record should preclude a skilled physician from using “vast knowledge of anatomy, biochemistry, physiology, and pathophysiology and interprets appropriate studies to arrive at the correct diagnosis.” Blaming the record is simply dissembling. It’s the equivalent of a carpenter blaming the saw because he cut the board a foot too short.
Johnson, and is ilk, are precisely the reason that modern healthcare sorta sucks in the US. Physicians with huge egos, minimal skills, and weak knowledge still think that hand holding is a reasonable substitute for actual knowledge (if that were the case Joh son could have gone to chiropractor school and saved a ton of money). They are frankly afraid to subject their professional performance to rigorous scrutiny for fear of discovering their broad inadequacies.
Johnson bemoans the loss of the “dictated and transcribed note”
The once thoughtful and educational consult note is now pages of worthless computer-generated gibberish.
Electronic notes can be just as thoughtful and insightful. The though and insight come from the user, not the computer. This is an example of a PICNIC problem- Problem In Chair, Not In Computer. If Johnson’s notes are not “thoughtful and educational” then it’s a user input error not a computer limitation.
I’m not fan of electronic records either. But it’s a user problem, not inherent in the technology. Doctors simply need to be doctors and stop whining about the computer. Maybe whining doctors simply weren’t very good at doctoring. Now we can actually measure that.
Johnson’s whiny rant is a perfect display of all the things a doctor shouldn’t be. It’s a graphic demonstration of how to show the world your worst side while railing against progress. Never once does Johnson propose an alternative other than “the way we used to do it.” He’s clearly not one of the innovators at whom he pokes fun.
You should read Johnson’s piece. If you’re one of his patients, you should definitely read it.