ChesterCountyMedicine Spring 2018 - 7
I can diagnose
QUALITY OF CARE
What exactly is quality of care? The basic concept currently
used is spending the least amount of money to give the best care.
Parameters set up in the past have not been very effective. It's more
gaming the system with a lot of data accumulation in EMR which
is than rewarded by payers. How do we measure true quality? That
great doctor that comes in the middle of the night to see a patient
does not even get a penny more compared to someone who spent
ten minutes in regular hours seeing a patient and typing a threepage note.
Unfortunately measuring quality is not easy because even
if you look at morbidity and mortality those who take care of
sicker patients will have outcome issues and documentation is
what counts. So despite our busy schedules we have to extensively
document everything and more if we are to be successful.
Not only that, if we are typing our notes in front of patients it
results in lack of communication and again a feeling of disconnect
between patient and doctor. I can tell you many times my elderly
patients have told me that their physician was reading his emails
while seeing them.
ELECTRONIC MEDICAL RECORDS
I have already mentioned some of the issues we face in the
electronic world. Besides time and effort needed to just keep up we
will need to be careful how we use EMR.
So far we have been lucky with a combination of EMR and
To keep ourselves safe we have to avoid certain pitfalls.
* Use of templates can be problematic because they are like
assembly line care and each patient is different and if we place the
same info it may not fit every patient.
* Copy and paste is used extensively by physicians because it
saves time but it can be disastrous in a lawsuit because a patient's
progress is dynamic rather than stationary and we must keep upto-date if we are to avoid legal issues.
* Keeping track of alerts and information: There is so much
information and alerts on EMR that one can miss vital data; it's
important to take your time reviewing the data and respond to
In essence whatever you put in EMR with a click of a button
you have to own up to in the future and forever.
I never thought I would say this but I think with shrinking
reimbursements and increasing regulations, we have to start
thinking of medicine at least partially as a business. We can still
care for and love our patients but we also have to be aware of and
involved in everything from contracts to hospital negotiations.
Try to maintain a balance between family and work, make use
of extenders and nurses, find time to decompress. I think we can
still be happy and satisfied in our careers. My greatest source of
satisfaction throughout my long career has been my patients and I
believe that's the case for most physicians.
Mian A. Jan, M.D., is a practicing Cardiologist
and President of Chester County Medical Society.
Contact Dr. Jan at 610-827-1543.
SPRING 2018 | CHESTER COUNT Y Medicine 7