stent<\/font><\/em> that opens the clogged artery [often for good]. <\/div>\nBut those changes were predictable. Medical science regularly marches upward. The changes I’m talking about are things like this article from the PSYCHIATRIC<\/font>NEWS<\/font><\/strong> focusing on Risk Management<\/font><\/em>. Fifty years ago, had you handed me an article about Risk Management<\/font><\/em>, I would’ve been curious to know what it was about – assuming that it would be about the risk patients faced from their diseases, or maybe their treatments. It wouldn’t have ever occurred to me that it would be about managing he doctors’ risk from the patients. In the first paragraph of the article where it gives the rationale for this kind of documentation, it mentions promote patient safety and minimize error<\/font><\/em> in passing, but most of it is about preemptively heading off charges of negligence and\/or malpractice. And it ends with Failure to document is not only unethical but can lead to license revocation, restriction, or disciplinary actions and also the inability to defend a malpractice claim<\/font><\/em> – suggesting that one should Provides<\/strike> evidence of professional credibility<\/font><\/em> in every note.<\/p>\n![](\"http:\/\/1boringoldman.com\/images\/emr.gif\")
I suppose the suggestion that this kind of micro-documentation might make sense if the time allotted for a patient visit included the time it takes to write this kind of note, but that’s not the case. And we might add in the use of an Electronic Medical Record <\/font>[EMR<\/font>] system built to contain all of this information [most of which don’t have psychiatry in mind]. And perhaps others are more comfortable than I am being a clinician who is looking primarily at a computer screen. But those are just a few examples of the ground clutter choking medical practice. There are plenty of other things – things like screening [BP, P, PHQ-9, etc.].<\/p>\nAs a free clinic staffed by retirees with only one paid employee [the Director], our little clinic was a great place to work even though we operated on a wing, a prayer, donated and generic drugs, and old people. Then came the decision to take insurance from those that had it – to get certified. Over the last year, the volunteer physicians, nurses, pharmacists, etc have all left [except for me] – and I’m finally mustering my way out over the next 3 or 4 months. It has been heartbreaking to see things change so quickly in spite of the well-meaning powers that be who tried to keep it from happening. I naively thought I could Ostrich my way through it, but I can’t bring it off in spite of trying.<\/p>\n
And, by the way, being asked to give evidence of professional credibility<\/font><\/em> in case of a lawsuit in every note takes time away from actually being professionally credible…<\/font><\/em><\/sup><\/div>\n","protected":false},"excerpt":{"rendered":"Good Risk Management Requires Good Documentation PSYCHIATRICNEWS by Anne Huben-Kearney, R.N., B.S.N., M.P.A. October 31, 2016 The importance of good documentation cannot be overstated. Documentation can provide evidence of care provided or not provided; serve to promote patient safety and minimize error; ensure regulatory, accreditation, and reimbursement compliance; provide an effective defense in a medical […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-69100","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/69100","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=69100"}],"version-history":[{"count":20,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/69100\/revisions"}],"predecessor-version":[{"id":69121,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/69100\/revisions\/69121"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=69100"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=69100"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=69100"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
![](\"http:\/\/1boringoldman.com\/images\/stent.gif\")
At the time I was an Intern, we were just begining to realize that patients died from arrhythmias in the period just after a heart attack and had begun to monitor<\/font><\/em> the EKG – a major advance. Now there’s a monitor in every hospital room, but in the period just after a heart attack<\/font><\/em>, the patients don’t go to their rooms. They usually go to a cath lab for a stent<\/font><\/em> that opens the clogged artery [often for good]. <\/div>\n