In response to reader comments on David Burda's "Reporter's notebook: EHRs put some docs on edge":
Sylvia Landry's sanctimonious comments to Jo Kriynovich's concerns are out of line. I am guessing that you will be inundated with similar rebuttals. If physicians themselves enroll for a training session, they should make an effort to attend. How would you as a patient feel if your scheduled physician appointment was just canceled with no notice? Simply as a common courtesy, the trainer should be notified that the clinician scheduled to attend has to cancel.
Very little physician time, particularly in the private office environment, involves "saving lives." We could go into the journal studies here which find that up to one-third of surgical procedures are unnecessary. It involves filling out insurance paperwork, phoning in prescription refills, and signing checks to pay the staff and the bills, in addition to examining and treating patients, many of which have self-limiting conditions such as viral respiratory infections. How many prescriptions for antibiotics are written for patients who have influenza?
A recent study, highlighted in a New York Times op-ed by Daniel Carlat, indicated that more than half of physicians' required continuing medical education is financed by pharmaceutical companies. Learning why Avandia and Vioxx are good for patients is less critical than learning about clinical data systems. And, incidentally, leaves patients worse off. One-half of Medicare payments to hospitals are for "dying patients" during their last six months of life. The cold fact is that they still die.
I know many nurse educators who are payroll-classified as exempt (i.e., don't work regular shifts and don't get overtime or shift differential pay). They aren't "hourly wage people" as Landry implies. Indeed, "classes are presented during the day, at night and on weekends to cover the myriad schedules worked," as Kriynovich notes. Trainers often carry pagers. Evidence is accumulating that clinical information systems save lives by avoiding medical mistakes and highlighting potential adverse events before they occur, as well as presenting a longitudinal patient history not limited to the findings of the current episode of care.
Michael MundorffPrimary Children's Medical CenterSalt Lake City To submit a letter to YOUR VIEWS, click here. Please include your name, title and hometown.