A contrarian view of medical "paperwork"

Being true to my contrarian roots, I am going to take a contrary view related to medical paperwork. The term paperwork is really not entirely apropos since much of this documentation happens in the digital world. However, we still speak of dialing phones which have not had dials for decades. In a recent blog from the Medical Skeptic (http://medicalskeptic.wordpress.com/2010/04/09/doctors-and-patients-lost-in-paperwork/), the author highlights recent studies which underscore the fact that doctors are spending more time with paperwork than in the past, resulting in less time with patients.

It prompts me to ask what has changed to prompt such a change in behavior? The stock answer is physicians are saddled with more bureaucratic mandates to comply with regulations and justify their billings. I suspect that this is true to substantial extent, but I would argue that independent of all the mandates and billing documentation our writing and documentation  requirements would have and will continue to increase in the future.

The reason is simple. Medicine has moved from a solo, lone wolf activity to a team activity. As well specialize more and more and participate more as a cog in a larger team, our need to communicate with other team members will increase. The safety of patients absolutely requires better communication between health care team members. That communication can only occur by taking time, generally not in the presence of patients, to reflect and document what you are thinking in a format that can be seen and digested by other health care professionals participating and making decisions relevant to a given patient.

 It is unfortunate that the present circumstances have conspired to prompt physicians to use the medical record more to comply with useless mandates and avoid billing fraud accusations while distracting physicians from the actual communication with other essential team members. This is simply a distraction created by narrow minded control freaks who have high jacked the entire process. That we engage in this essentially useless activity should not make us believe that all the time that we devote to working that is not face to face encounters with patients is wasteful.

Ours is a profession which requires both action and reflection. Our time with patients provides them with value only if we are not always shooting from the hip and our plans are the product of thought and exchange, neither one of which is valuable unless we accept that documentation is required for creating value from the thought by enhancing communication.