Why I Read Charts (of my admitted patients)
I recently treated two patients, one with chest pain and one without.
The one without chest pain was much sicker with some dangerous arrhythmias, and while his initial cardiac enzymes in the ER were negative, the following morning his troponin was over 50. Yet he survives, so far, despite his advanced age.
The one with chest pain didn't seem particularly sick at all, and his Cardiologist was unimpressed with my presentation. Stable ECG, negative cardiac enzymes, and atypical features in an anxious patient with a previously negative workup suggests maybe he could go home, said he. Fortunately the Hospitalist agreed to admit him after some negotiation. This patient expired the next day.
Reading the electronic medical record of my admitted patients gives me perspective and feedback that is difficult to acquire in any other way. Apparently some HR departments frown on such intrusions into patient privacy, one more way that bureaucrats with good intentions sabotage the practice of medicine.
In my experience, patients are grateful that I care enough about them to learn how things went after our brief interaction in the ER.
The one without chest pain was much sicker with some dangerous arrhythmias, and while his initial cardiac enzymes in the ER were negative, the following morning his troponin was over 50. Yet he survives, so far, despite his advanced age.
The one with chest pain didn't seem particularly sick at all, and his Cardiologist was unimpressed with my presentation. Stable ECG, negative cardiac enzymes, and atypical features in an anxious patient with a previously negative workup suggests maybe he could go home, said he. Fortunately the Hospitalist agreed to admit him after some negotiation. This patient expired the next day.
Reading the electronic medical record of my admitted patients gives me perspective and feedback that is difficult to acquire in any other way. Apparently some HR departments frown on such intrusions into patient privacy, one more way that bureaucrats with good intentions sabotage the practice of medicine.
In my experience, patients are grateful that I care enough about them to learn how things went after our brief interaction in the ER.
Labels: health care crisis, patients, pencil-pushing idiots
posted by scalpel at 11:12 AM
9 Comments:
This is exactly why I read your charts too.
I think it's idiotic not to follow along and see what happens to patients you admit. We do not get in trouble for doing this, unlike some places apparently.
As far as I can tell, it's only the nurses that are getting fired for this; although, it seems that, in theory, there is no doctor-patient relationship between an ER doc and a patient after they leave the dept and the rules should be applied uniformly if those are the [stupid] rules that they want to adopt. I think that both nurses and doctors are missing out on excellent learning opportunities if they are not allowed to see what happens to a patient later on in their stay, but that's 100% forbidden at my hospital.
The nurse who was fired from my hospital for accessing a patient chart who was not in the dept did so on a patient she had who had coded unexpectedly and had to be transferred to the ICU. All she wanted to know was if they determined a cause for the code! And they fired her for wanting to know that! That is IMPORTANT to know.
WTF! You guys are getting disciplined for following up on YOUR patients after admission. Are you kidding??!! I tell anyone I'm precepting that that is one of the best ways to learn. Always follow up on your patients so you'll get a broader picture of what each disease can look like. It's kind of essential to know whether you're on the right track or not. I have followed up on any patient that I could since I was an EMT over 20 years ago. One of the first things I do when I come to work is to review my patients from the previous shift and what happened with them.
-whitecap nurse
First thing I do when I start a shift is go into the computer where I can look at a list of my patients that are currently admitted.
Maybe there should be a national database of hospitals that fire people for following up on patients.
I would think the union would have something to say about this counterproductive rule. Or is the problem that the hospital has a specific procedure that they want followed to obtain information about patients?
The union is actually fighting that nurse's termination, but, wtf, we're all scared to LEARN now. Some nurses won't even read charts of patients they triaged to see if they were triaged correctly.
If you didn't follow up, how would you know if you missed anything, or if you made a particularly good call? For good or bad, in small town Canada, patient privacy is pretty hard to guarantee. Everyone updates you on your patients.
rofl
So, you get fired for making patients health a priority.
Reason: Not protifable.
The USA really does have the best medice money can buy.
Good thing you don't have commie socialist imperialist public health care system in place. You may get a promotion for being good at your job.
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