Hitting a Nerve

Forgoing EMR templates for artisanal notes


I’m a medical note artisan.

Does that term sound overused these days? Well, I’ll stand by it. I handcraft medical notes from nouns, adjectives, verbs, habitual phrases, and other constructs of language.

In an era of mass-produced generic EMR notes, often indistinguishable between doctors, or even specialties, I scorn templates and type mine (or dictate them) fresh for each patient.

A doctor holds a chart copyright BrianAJackson/Thinkstock
Why do I do this?

Perhaps I’m just old style, though it can’t be from my age. One area neurologist who’s older than I am has encouraged me to switch to using templates. He emphasizes how much time it saves. I don’t bother telling him that his physical exams never change, even though the patient clearly has.

Another, also older than I, has gone even further. Rather than taking his own history he just cuts and pastes it from the admitting internist’s note. I’m sure that saves a lot of time, too, although it will probably come back to bite him if the records ever come up in a legal case.

Notes today are all sizzle and no steak. Templates feed in test results, allergies, medication lists, etc. It’s not that these thing aren’t important, but they overshadow the note’s purpose of stating what’s going on with the patient and what you’re trying to do about it.

Dr. Allan M. Block, a neurologist is Scottsdale, Ariz.

Dr. Allan M. Block

I’ve always tried to make my notes tell a story (albeit a short one): What’s going on, why I think that, and where we’re going. On a day-to-day and visit-to-visit basis, I rely on my notes to see how things have changed, what we’ve tried and failed, and so on. My goal is that, if I look at a note a day, a month, or even a year or 2 later it gives me a good idea of where we left off. If every note looks alike and the plan isn’t clearly stated, I have no idea where I’m going.

Does it take me more time to do this? Probably, but on the flip side it saves me time later when looking to see if an exam has changed or trying to remember what my plan was.

And, like any artisan would say, I’ll take quality over quantity any time.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

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