Examine training, EHR issues

Regarding “Diagnostic errors common in primary care, study finds”:

This article brings up several important issues. Time is of the essence in medical care today. Physicians have a limited period of time to collect the relevant information and the clock is always ticking. I am not really sure how medical homes or ACOs are really going to address that, but time will tell.

Two issues not addressed here are at least as important. First in my mind is the lack of good outpatient training in most medical programs. Residency is often disproportionately weighted to inpatient care while real-world internists and family practitioners spend 90% of their time in the clinic. As a newly minted doc two decades ago, I was woefully unprepared for outpatient medicine. Much of what I know now was learned over the years through my interaction with specialists and trial and error, but this is clearly not the best way to train new physicians for a career in outpatient medicine. I often see other patients who come from other doctors after being treated inappropriately for a sinus infection because the doctor in question has never been adequately trained to understand that one week of nasal congestion does not equate to a bacterial infection necessitating antibiotics.

Another important issue of more recent development is the implementation of EHRs. While they have been promoted as a method to reduce medical errors, I view this as an opportunity missed. EHRs certainly have the potential to eliminate medical errors by placing the most important information in front of the physician. Unfortunately, many of these systems actually make it harder for physicians to find what they really need.

Clearly, there needs to be more study to determine what information is most critical in what situations so that systems can be designed to put all critical information at the doctor's fingertips either by putting it on a single page or by creating flags or other means that don't require the doctor to click through multiple menus to find what they need or what they are not even aware they need.