All Patients Look the Same in Today’s EMRs

The other day I had to handle an issue for another provider’s patient. In my conversation with the patient, I learned that they had gone through a relationship breakup and a major health crisis two months ago. One month later they had seen their PCP for a brief visit to recheck on a chronic problem. The note from that visit was full of details pertinent to that issue, but made no mention of the double crisis the patient had just gone through.

There are two forces behind situations like this. One is the time pressure in primary care practice and the other is the template driven documentation. So many EMRs have specific templates for specific problems. Most also let us providers create our own templates, which may not even have fill-in-the-blanks, but a whole normal visit that you can populate the chart with in just one click.

In today’s clinical documentation, the individuality of each patient tends to get lost. So much of the data in our office notes is structured and so much is boiler plate or copy and paste. The story is missing so much of the time.

Many if not most other “industries“ drill down on the uniqueness of their customers. Our social media feeds bring ads for things we have searched for on other websites, for example. Advertisers pay big money for such information so they can customize their approach to each of us. Medicine is the opposite: Doctors are encouraged or downright required to cover the same things in each office visit and to document it in the same, easily extractable, fashion. Narrative Medicine is a minority fringe, it seems. And this is in spite of everything we know about social determinants of health, genetics, epigenetics, mind-body medicine and psychoneuroimmunology.

My visit with this patient that I had never seen before lasted all of 10 minutes. You can learn a lot in such a short time. Why don’t we?