Meaningless Use

Are all questions necessary for all patients, or should the history be focused? As medical students, we were taught to do a detailed physical exam. That’s appropriate sometimes, especially if medical school graduation depends on it, but sooner or later we all learn that brevity is needed for survival. Some parts of the exam are critical, while others are expendable. For example, checking ear drums is very important for evaluating an earache, but useless for evaluating hemorrhoids.

By mindlessly passing out forms to every patient, we are not tailoring our approach to each patient, but adopting a "one-size-fits-all" approach for the practice of medicine. Maybe I’m just old fashioned and out of touch, but is it really necessary to request great-grandparents and members of the clergy to disclose information about their sexual orientation and practices? Perhaps these data will make our electronic records slightly less boring for hackers, although the hackers may be disappointed to find that many patients skip such sensitive questions. That doesn’t bother me at all, as patients have their own definition of meaningful use, but I hope the federal government will not subtract any of my brownie points.

Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind. You may reach him at rhnews@elsevier.com.