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Sep 15, 2023Liked by Hans Duvefelt, MD

I used EPIC for 5 months before I retired in 2019 at 65 and 1/2 years of age. I did not like it or the Allscripts we had before it, but I learned to make each one work for me. I showed this blog to my son who is a 40 year old family doctor. He practiced for 10 years on the Navajo Reservation at Winslow and now is a family doctor on the east coast and practices and teaches in a family medicine residency program. Since his med school days he's known nothing else but the EHR and over his career has probably used 4 or 5 or even more different programs. He's had his aggravations with EPIC. That being said he told me he very much likes the EPIC PT/INR flow chart stating "it’s pretty nice, prints out a calendar with the dose and how many of each tab to take per day." He goes on to add "I’d argue a better question is why does (the) American healthcare (system)still force us to use warfarin in 2023 (with the exception of mechanical heart valves and antiphospholipid syndrome)?" Why indeed. Eliquis here in the U.S. is over $500 per month. In Germany it is less than $100 per month. That would still be a stretch for a lot of Medicare patients. The CEO of Bristol Myers Squibb recently wrote an editorial in the Wall Street Journal where he claims that "Seniors on Medicare pay, on average, $55 per month for the drug." What planet is he on? He truly has no idea. He probably has never set foot in a pharmacy or gotten mail order prescriptions in his life. I have a stake in this personally as I'm on Eliquis. It is a 3rd tier drug for me in spite of at least 3 huge studies showing that it is far and away the most effective and safe drug, when compared to warfarin, for atrial fibrillation. Oops...due for my pm dose.

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No wonder so many doctors are exhausted and vexed. Now, how can patients advocate for change for the our doctors?

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Patients have even less say than doctors. Between the insurance companies (including CMS -Medicare and Medicaid) and the EMR vendors, even the health care organizations have little say about how we work.

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