Yesterday I spent about 6 hours sitting in front of a computer typing up discharge summaries for a number of patients on the ward I’m covering. They were all new admissions to my ward but most had been in hospital for a few weeks.
Because of the way departments are funded, the job of recording all the complications, procedures, treatments and outcomes onto the discharge summary is vital for keeping the unit going (economic rationalism has it’s foothold). The tricky thing is that when we take over a patient it is only through the patients documentation (progress notes and med charts mainly) and their investigations that an adequate summary can be made.
And this is where the waste comes in.
Of the 6 hours I spent at the computer I estimate that about 4 was spent trawling through separate databases for demographic, pathology, and radiology data then manually copying and pasting it into a stand alone word document. This drives me crazy. Essentially, instead of having an automated process that draws those data together into a single document, which is nothing groundbreaking in terms of IT (in fact it’s the whole point of databases), I have to wade through different systems with different logins to extract the data one hard earned bit at a time.
What is really sad about this is that I’m supposed to be learning more about clinical medicine. And developing my skills as a doctor. And spending time with patients. But the archaic IT infrastructure means I’m strapped to a desk, my stethoscope withering around my neck.
There have been numerous older clinicians lamenting the reduction in working hours for young doctors - the most reasonable argument they have is that it means doctors today don’t get enough time with patients and see the natural progression of disease and learn valuable clinical acumen. I’d say that a big part of not having that time is because there are so many poorly designed systems in place that don’t deal with the increasing amount of data that gets generated every time a patient arrives at a hospital.
Reform in this area is long overdue. And I know that there’s plenty in place in a move toward EHR and the like, but change is so slow in these monolithic institutions.
That is all.