Is Now a Good Time to Ask a Personal Question?
My Epic EMR discourages me from closing each office note without addressing the gender identity questions that are now suddenly mandated.
According to the American Journal of Public Health,
The same article reports that during the first year that this data collection was built into EMRs, 77% out of a combined patient population of over 25 million did not have the answers to these questions documented.
We have asked sensitive questions all along: Do you smoke, how much do you drink, how many sexual partners have you had in your life, did you ever think of killing yourself, are you the victim of domestic abuse?
I am not as convinced as many others about the validity of such rapid-fire questioning during the check-in process for a routine visit. And I am particularly concerned that sexual orientation questions delivered in a mechanistic fashion not only have limited accuracy but can go either way in terms of doctor-patient relationship. Some patients may be ready on that day to reveal such things, others who are not, may be seriously offended.
For me, this latest mandated probe illustrates this country’s two opposing views of the purpose of the doctor-patient visit and the two opposing views of the purpose of the patient medical record.
Is the purpose of the visit and the office note to give the patient the medical advice they seek, or is the purpose to collect statistical information for medical, actuarial, sociopolitical and public health purposes? The question is rhetorical. The record is certainly not, and much of what we do in our clinic visits also is not, for the patient.
Yes, I am old school, but medicine is an old practice. The doctor-patient relationship has its foundation in Hippocrates. Only lately have bureaucrats and statisticians hijacked this ancient tradition of privacy. If no medical record existed, I would feel much more at liberty to ask all kinds of probing questions, but neither I nor my patients have full confidence in HIPAA and confidentiality in today’s typical office environment.
I have written about this many times. What is it with our obsession with questionnaires?
And