With the latest firestorm in the media around Dr Oz, we decided to ask our members if they agreed that Dr. Oz should be removed from his position at Columbia University.  The results were definitive..

Of the 2,029 physicians who participated in our poll as to what Dr. Oz should do next, more than 1,500 physicians (78%) voted that he should resign from his faculty position at Columbia University.  More than 450 (24%) believe he should have his medical license revoked.  The poll is as follows:

Dr Oz should:

57% – resign from his faculty position at Columbia University (1128/1979)

3% – have his medical license revoked (66/1979)

21% – do both, resign from his position at Columbia and have his license revoked (411/1979)

19% – do nothing, I respect Dr Oz as a physician (374/1979)

Dr Oz can’t laugh this claim off as easily as he did on his show.  1,500 physicians is nothing to scoff at.  They’re not backed by big food or representing special interest groups, as he claims.  These are the clinicians and medical thought leaders across an entire spectrum of specialties and practice backgrounds, from rural generalists to his peers in cardiology.  These physicians are speaking up because they care about the information their patients get – PCPs who regularly combat all sorts of misinformation in the marketplace about vaccines and “magic pills”, ER doctors who drop everything to save anyone who’s coming in, with no secret agenda or undue influence from industry , surgeons  and other specialists who are caring for people with a wide variety of chronic ailments and are helping manage complex co-morbidities, or pediatricians who calm our fears as parents.  These doctors are the researchers who tirelessly work to cure MS and rare diseases (most of which affect children), the family practitioner who fights for patients when their insurance companies deny their claim, and perhaps less visible, they are the doctors advocating for truth and transparency about the information you’re fed from other physicians, their own peers, when they think someone of influence has it wrong.

Think viewers don’t take Dr Oz’s advice as gospel?  Think again.  One OBGYN shared:

“I have a patient with…menorrhagia, which she has been trying to manage with herbs over the last year.  So, while she refuses transfusion for no clear reason (not a {Jehovah’s} Witness), I am trying some tricks to get her ready for hysterectomy. When my nurse called to speak with her about other medical clearance the patient said…that YOU [Dr. Oz] are her managing doctor! So, my question is, where can I call to get her records and can you give her pre-op medical clearance?”

This is not uncommon.

We asked Dr Linda Girgis, SERMO member and Family Medicine physician for her thoughts.  She shared:

 “As doctors, patients trust us to pass on the best medical advice to them to enable them to make the best healthcare decisions. We have spent many years studying and training to learn the science behind what we are doing.  Legally, we are expected to practice within a certain standard of care (what other doctors are doing).

It is not acceptable for doctors to invent their own science. We have researchers and organizations that carry out clinical trials in order to keep patients safe. When we throw out that data, we are ignoring patient safety.”

It wasn’t all negative though.  19% of the SERMO doctors polled respect Dr Oz as a physician.  Most of the support voiced was because of his advocacy for GMO labeling.  Even his critics called for him to speak on behalf of physicians more, using his celebrity status for good.  Other physicians are torn, like one of his Cardiothoracic colleagues…

“I have watched Dr Oz operate and he is a good surgeon, seen him interact with patients and he truely cares about them, and performed well done medical research with him. As a heart/lung surgeon I respect him. However, when I watch his show I just cringe when he talks about a pill containing a combination of herbs/roots/chemicals to solve one or any problems or when he talks about womens’ orgasms! Does he (or anyone) really know what that pill does, it’s side/long term effects are, or alternatives to this pill? No good studies have been done on half those pills, and the other half maybe good science but of questionable or no benefit. Which to believe when he speaks? He is using his good and well deserved surgical reputation to mute any criticism or questioning of the promotions on the “show”. It truely is sad. Shame on Columbia for supporting this bad behaviour. Freedom of speech does allow snake oil salesmen to practice but it should not allow a trusted physician to do the same thing while being a physician or supported by a great medical school. Mehmet- if you really want to promote unproven therapies then resign from Columbia and us the small remaining medical capital. If you want to continue to be a trusted doc, then promote RESEARCH that proves these pills work and tell the truth about these products.”

We also asked SERMO doctors to share questions they’d ask Dr Oz, if given the chance.  Then we gave them the chance!  These questions were tweeted @DrOz and can be found at #SERMOasksOZ.

Here is a taste of what you’ll find:

It’s not easy to be a doctor and make money any other way because of the level of scrutiny you’re put under.  Our doctors understand that better than anyone else.  What is unacceptable is when unsubstantiated advice is given to the public, as a physician, for financial gain.

Dr Girgis shared:

 “A celebrity doctor should be held to the same standards as all doctors. Maybe even more since they are reaching a larger audience. When someone in that position starts giving advice that is not founded on science and has not been proven safe, it is not in the best interests of the well-being of the health of the viewing population.”

We’d like to invite Dr Oz to come in and do a Q&A with our community.  We’re not wielding pitchforks…we’re your colleagues and just want to separate fact from fiction, advocacy from advertisement and ensure that physicians are empowered to deliver the best, clearest, most responsible information we can to patients everywhere.

We discuss this and a myriad of clinical topics inside SERMO. If you’re an M.D. or D.O. in the US or UK, please join us.

The post More than 1,500 Physicians Call for Dr. Oz to Resign appeared first on Sermo.

We posed this question to the SERMO community recently; the results and discussion shed light on physician sentiment.

Should compassionate use be allowed for unproven drugs or therapies?

• 74%    Yes, but only when the patient has no other options
• 19%    Yes, clinical trials take too long
• 7%      No, it’s unethical to do so

What Doctors Think of Compassionate Use

In the wake of Ebola and the use of experimental treatment options and rushed vaccine trials, many doctors discussed the pros and the cons. A family practitioner wrote, “As with almost everything in medicine, you weigh the risk of the treatment and the disease to the benefit and try to make an intelligent decision. In Ebola, the risk of the disease is astronomical, so even a little benefit or a potential benefit is acceptable. If the benefit is essentially zero, as in many alternative treatments, then even a small risk of treatment outweighs and precludes its ethical use. “

A surgeon countered, “these treatment options are offered at a time when coercion is remarkably easy. “What have you got to lose? Are you going to miss out on a potential cure?” and worse, to families, “Are you gonna let money stand between you and the chance to save your parent/spouse/child?”

“Compassionate use has to be offered in a VERY circumspect fashion, and patient and family must be treated as fairly as possible,” he continued. “And frankly, I’m not sure that playing fair with families, in this situation, is EVER possible.

A second family practitioner talked about private insurance decision-making. “I was frequently presented this question when I was in charge of medical policy for a large insurance company. Cost was not the main consideration; plausibility was. This is, there had to be a good reason to believe the proposal could work.”

Several doctors voiced the need to take profit out of the equation when making these tough decisions. An internist wrote, “compassionate use should be mediated through the 340B drug program to avoid profiteering from a serious illness scenario.”

As a physician, what do you think about compassionate use? Has the recent Ebola crisis and the experimental drugs used on some patients changed your perspective? Have you ever had the opportunity to assist a patient through a compassionate use scenario? We discuss this and a myriad of clinical topics inside SERMO, if you’re an M.D. or D.O., please join us.

The post Poll: How doctors feel about compassionate use appeared first on Sermo.

A recent SERMO poll found 92 percent of doctors think the current measles outbreak is directly attributable to parents who do not vaccinate their children.  Further, a physician poll conducted in August 2014 found the majority of doctors think unvaccinated children should not be allowed to attend public schools.

Public health officials agree, last week a California high school barred 66 students from attending school for not having the MMR vaccine when a suspected measles case appeared in the study body.

Measles Infographic

Our infographic shows the importance of a measles vaccine, and its impact on patients.  A recent discussion inside SERMO talked about the problem. One internist wrote, “It is dangerous for every other patient in your practice. An anti-vax kid brought in by a parent for a rash sitting in the waiting room of a busy pediatric practice could spread measles to countless others in a matter of minutes.”

Some doctors believe seeing non-vaccinated patients is an opportunity to educate. An OBGYN wrote, “We have a large community of anti-vaxxers in my state, and it would be difficult to refuse them outright. Instead, I use persuasion to try to educate them and make my advocacy position very clear. I have had some limited success with this tactic.”

The American Academy of Pediatrics has urged doctors to respect each patient’s preferences but continue to educate about vaccinations unless there is a heightened medical issue for getting a vaccine.

What do you think about vaccinations and the current measles outbreak?  Should unvaccinated children be banned from public schools?  Should doctors urge patients to get vaccinated and turn away those who refuse?  If you’re an M.D. or D.O. you can join the conversation right now inside SERMO.

The post Measles Infographic on Current Epidemic appeared first on Sermo.

Announcing our new Hubs: Neurology & Allergy and Immunology

Today, SERMO is excited to announce two new additions to our growing family of informational Hubs. Hubs are centered around specific disease states or specialty areas.  This is part of our commitment to bring you up-to-date, clinical information to our physicians.  The new hubs are:

• Allergy and Immunology
• Neurology

Physicians who specialize in these two areas will now have the appropriate Hub as their home page.  The Hub includes weekly expert articles written by peers,  focused polls and videos.  This means a neurologist will be able to view the Neurology Hub right on their member homepage.

Hubs are led by physician peers with, over 45 physician writers providing top-flight discussion topics, research, and authoring polls for fellow members. They’ll be discussing the latest research, trends in your specialty and clinical best practices.

These HUBs unite the best of what Sermo offers in a collaborative space that includes:

• Specialty or disease-focused polls
• A Multimedia Channel for the latest related video content
• Fresh, breaking posts from your Sermo peers
• An inside look into related discussions on Twitter
• New research, resources, and upcoming conference updates

If you are an M.D. or D.O. you can join the SERMO physician community and interact with your peers immediately.  Membership is free and all physicians are verified.

Interested in the other Sermo Hubs?  Visit them now.

• Multiple Sclerosis
• Oncology
• Diabetes
• Cardiology 
• Obesity
• Infectious Diseases
• Depression
• Bipolar Disorder
• Dermatology
• Pain Medicine
• Rheumatoid Arthritis
• Gerd
• Asthma 

We wanted to thank our physicians for creating such an active, vibrant community.  Approximately 60 percent of our content is clinical in nature.  One of our most used features is SERMOsolves, an app doctors use to upload patient information and collaborate on diagnoses and treatment plans.

The post Two New Hubs Announced for SERMO Physician Social Network appeared first on Sermo.

Telemedicine has been around, well, since the telephone. But the definition of telemedicine is broadening to include any electronic interaction between patient and doctor. For the first time, doctors in 22 states receive compensation for telemedicine consults. We asked doctors what they thought of the changes.

Overall, 71 percent of doctors say they would participate in telemedicine with their patients if they received compensation. Only 29 percent said they wouldn’t use phone, email, or video means of communication.

Doctors Support Telemedicine

While the majority of doctors support telemedicine, all of them had caveats for proper use. One family practitioner listed where it is most helpful:

• For remote patients to improve care and save the patient time and money
• To help send patients to the proper medical facility such as urgent care centers over emergency departments
• To help abate the physician shortage by quickly and efficiently using doctor’s time
• Doctors are typically paid $30 for a 10-minute consult

We even heard from physicians who are currently working through telemedicine. One geriatric physician, who works part-time via an online telemedicine network, wrote, “Patients can show rash, throat or any other snaps of their ailment. We can write prescriptions except narcotics and psychiatric meds. My network has over 65,000 US doctors now.”

Physicians Against Telemedicine

Many doctors voiced concerns about missed diagnoses, further straining doctor/patient relationships and the increased likelihood of lawsuits.

A nephrologist stated, ”Have good tele-malpractice insurance, the state medical boards love to sue for tele-prescriptions that are devoid of face-to-face evaluations.”

“The greatest foe is not necessarily telemedicine, but its attendant laws (or lack thereof),” wrote a psychiatrist. “The legal system moves glacially compared with technology, for many years to come, a jury will not be kind to the physician who makes a mistake over Facetime.”

Patients Demand Telemedicine

Many doctors cited rural patients and patients with chronic but manageable disease as perfect candidates for telemedicine. A neurologist noted that population changes could spark increased requests. “As the elderly patients who aren’t tech savvy age out of the system, and younger patients are used to communicating with each other in these ways replace them, they are going to demand telemedicine,” he wrote.

Is it Really a Big Deal?

Many doctors wrote that telemedicine has been happening for years with few problems. A cash-only doctor wrote, “Physicians have been doing telemedicine for years- all those phone triages are telemedicine. It’s all about knowing when it’s appropriate and when a patient needs to be seen.”

While most doctors support telemedicine, do you? As a physician, have you tried it or are you waiting for reimbursements to begin in your state? Would you even have a nurse practitioner or physicians’ assistant handle telemedicine on your behalf? There is an active discussion on SERMO, if you’re an M.D. or D.O. please join us.

The post Most Doctors Support Telemedicine appeared first on Sermo.

Does air pollution cause autism?

As we settle into 2015, quite a few announcements and research results are making waves this week.  Let us know which stories piqued your interest.

Autism and Pollution

A new study released this week from the Nurses Health Study II cohort looked at over 113,000 women around the issues of autism and pregnancy.  Researchers found a correlation between air pollution particulate during pregnancy, particularly during the third trimester, and children later developing autism.

3D Printing Preps Surgeons

In two separate cases, patients created 3D images to guide surgeons before the surgery took place.  A man in England printed out his kidney to help his surgeon pinpoint and remove a kidney stone.  A female patient was facing a tricky removal of a tumor above the eye.  Her husband printed and shipped a 3D image of her skull with the tumor to help surgeons prep for what turned out to be an innovative, minimally invasive procedure.  Other medical centers are catching on and we think this could be widespread soon.

Wounds Monitored by Smart Phone

Wounds don’t always heal properly.  Currently, the only way to monitor healing, is to unwrap the wounds and poke, even smell, the area for signs of infection.  Researchers at Mass General Hospital developed a “smart bandage” that is painted on the injury site and measures oxygen levels.  If oxygen levels are low, the bandage will show the area in red, indicating further medical assessment.  The best part, a doctor can check in via smart phone without needing to see the patient.

Head of Medicare/Medicaid Stepping Down

Marilyn B. Tavenner, the head of Medicare and Medicaid will be stepping down in February.  Tavenner oversaw the roll-out of the ACA including the complete botch of the federal insurance signup site.  The White House has not named a replacement.  Do you think Tavenner leaving is good for Medicare/Medicaid?

Assaults Against Doctors Common

We made the news this week when we released poll results from over 2,000 physicians.  Seventy-one percent of doctors reported being the victim of either verbal or physical assault.  The SERMOpoll sparked discussion on social media; many health care workers talked about their experiences.  How would you limit assaults on health care workers?

Physicians constantly share the latest research and medical news inside SERMO.  If you’re an M.D. or D.O., please join us; membership is free.  We are the most influential physician community in the U.S.

The post Medical News Roundup: Great tech and a big political move appeared first on Sermo.

Eighty-eight percent of physicians in the US think obesity should not be declared a disability after a Dutch court ruled for a plaintiff seeking damages, claiming his weight was a disability. The ruling is binding for the European Union and could mean big changes for companies accommodating employees with work-related weight issues.

The Denmark court rules in favor of a childcare worker who fired for being unable to perform his job due to his weight. According to the BBC, the court said, “if obesity could hinder ‘full and effective participation’ then it could be considered a disability.”

To further clarify, “obesity in itself was not a disability – but if a person had a long-term impairment because of their obesity, they would be protected by disability legislation.”

The Danish court appealed to the European Court of Justice (ECJ) for clarification, and the ECJ returned the opinion on obesity and disability. ECJ rulings are binding for all EU member nations.

Do US courts have an opinion?

In a handful of cases, some local courts have found for the plaintiff on the grounds obesity is a disability as defined by the Americans with Disability Act (ADA). In 2008, new guidelines for the ADA widened the definition of disability. In one 2011 case, the judge found obesity was a disability for a fired 527-pounds woman who worked for a non-profit. To date, none of the cases have reached a statewide or national level that would affect US companies in the way the EU ruling has.

What doctors think about obesity as a disability

As our poll numbers indicate, doctors strongly disagree with obesity being the sole reason to obtain disability status. “There are legitimate medical illnesses that cause obesity, and these should be respected as such. However, the vast majority of obese individuals do not have medical illnesses and are not entitled to disability,” said Dr. Andrew Wilner, neurologist and SERMO member.

Another SERMO member, Dr. Linda Girgis, a family practitioner wrote, “The key to solving this problem is prevention, not enablement. Governments should invest in curbing the epidemic and preventing obesity.”

As a physician, what do you think of obesity as a disability? Have you seen a patient who faced discrimination due to their weight? Do you think obesity guidelines should be set by Body Mass Index (BMI)?

We will be discussing this further inside the SERMO community, come join us.

The post Doctors Say No To Obesity As a Disability appeared first on Sermo.

An astonishing 71 percent of physicians say they were verbally and/or physically assaulted by a patient at some point in their careers according to a recent SERMOpoll.  If anything, violence against doctors seems to be increasing.

According to the Bureau of Labor Statistics, health care workers are assaulted at a rate of 146 per 10,000 workers in a given year. This compares to a national average of only seven assaults per 10,000 workers.

While 71 percent of physicians overall reported assault, the numbers vary greatly by specialty:

• Emergency Medicine: 93%
• Psychiatry: 90%
• Family Practice: 78%
• Internal Medicine: 71%
• Pediatrics: 64%

Here is the full breakdown of the poll for all physicians: Have you ever been assaulted?

• 44%    Yes, verbally
• 29%    Never
• 22%    Both
•   5%    Yes, physically

As seen from the breakdown above, one of the toughest specialties to work in is Emergency Medicine. In a study of 96 hospitals, 34 percent reported a rise in patient and family violence in the ER, while 29 percent reported an uptick in patient and family violence against other staff.

Charges Often Not Filed

A physician posted on SERMO about a violent incident he was involved with in a lockdown psychiatric ward with a patient with a “shiv.” He attempted to press charges against the patient but neither the facility nor the local police supported the decision.

Another psychiatrist wrote, “In the best of places, the docs rally together and push the DA to press charges even if the hospital doesn’t want to consider it. I have several times done an immediate MSE/competency exam on a patient that assaulted a colleague with the explicit goal of determining if we should press charges.”

Decreasing Assaults

Should doctors have training to protect themselves from possible assault? An article in LaborNotes, an online site for nurses, suggested four steps to improve safety.

1. Improve hospital reporting of assaults
2. Improve training for violence prevention
3. Boost security personnel and other security measures in hospital settings
4. Regulation to hold hospitals accountable for violent behavior by patients

How this Impacts Healthcare

The last thing anyone wants, is health care workers who are afraid to go to work. The impact in workdays lost, on the job stress, and practicing “defensive medicine” are taking a toll on the medical system.

As a physician how do you handle assault from patients? Have you found an effective way to diffuse situations before they get out of hand? Have you ever had difficulty working with police when a patient attacks you or staff? We will discuss this in detail inside SERMO. Please join us.

The post Violence Against Doctors: It happens more than you think appeared first on Sermo.

Medicine and technology will continue to integrate creating the biggest trends in medicine in 2015 according to a poll of physicians from SERMO.  The top three trends to look for are:

• Remote patient monitoring through wearable apps
• Telemedicine expanding with compensation to physicians
• More genetic discoveries to improve patient diagnoses and care

Remote patient monitoring via Apps

Cardiologists are familiar with the strap on heart rate monitors that then must be sent to a lab for analysis.  What if you could skip that step and monitor a patient in real-time, at the click of a button?  From a contact lens that monitors a diabetic’s insulin levels, to a smart phone app that detects behavioral changes when the flu is coming on, there are many areas of research with promising early results.  In the video below, Dr. Sandy Pentland from MIT’s Media Lab talks about how veterans with mental health issues can be tracked when medications are adjusted to see if they are working.

Caveat:  Physicians need solid research proving the devices and apps are as effective as current monitoring systems or improve on diagnostic tools already in place.  Without those standards in place, they will be at a greater risk for malpractice suits.

Telemedicine expands

Instead of coming in regularly to check on insulin levels, what if a diabetic could handle it all remotely with a quick phone or video call with their doctor?  Or what if a specialist hundreds of miles away could review records electronically and offer a consult without putting the patient through unnecessary stress or travel?

Telemedicine has been around for decades but with a boost from technology it’s got new legs.  Physicians can easily share patient files with anyone, anywhere.  While some patients absolutely need to see a doctor in an exam room, there are many instances where a video call can be just as effective.  This has particular value with monitoring patients with long-term, but manageable disease and in rural parts of the country where access to specialists may be limited.

Caveat:  Currently most private insurers and government reimbursement programs do not cover telemedicine.  Many physicians who consult electronically can not get reimbursed for their time.  We need to look at laws and guidelines that will open up this treatment option.

Genetic discoveries continue

2014 saw several genetic discoveries, perhaps one of the most important being a genome sequence for under $1,000 when just a few short years ago it cost tens of thousands of dollars.  Acting in the opposite direction, the FDA’s squelching of genetic information to laypeople via companies like 23 and Me dampens database growth and big data research, while perhaps protecting potential patients from false or missed diagnoses.

The video below from genetic researcher John Quackenbush, Ph.D., professor at Dana-Farber Cancer Institute and Harvard School of Publish Health discusses the intersection between genomics and how physicians can use it with their patients.

Caveat:  We’re still in the early days of genomics research, physicians need to watch the research closely for where it can best help their specialties and their patients, particularly with rare disease diagnosis.

Complete Poll Results

We asked our physicians to predict the Top Three Trends in Medicine for 2015 (choose three).  We’ve already discussed the top three vote getters.  Below are the full results:

• 42% patient monitoring using wearable apps
• 41% telemedicine taking a foothold and becoming compensated
• 39% more genetic discoveries
• 36% an Ebola vaccine
• 29% new diabetes medications coming to market
• 28% interoperable EHR systems
• 20% breakthroughs in cancer treatment
• 16% a migration to DPC models of payment
• 13% improvement in the efficacy of the influenza vaccine

As a physician, what trends do you think will uptick in 2015?  From the list above what do you consider the Top 3?  If you’re an MD or DO please join us inside the Sermo physician community for further discussion of the latest research and medical techniques.

The post Poll: 2015 Trends in Medicine appeared first on Sermo.

click to enlarge

 
~ by Linda M. Girgis, MD, FAAFP

Starting in January 2015, all physicians in Massachusetts must use an electronic health record system or face disciplinary action that could result in the loss of their license to practice medicine. Doctors fear these laws will spread to the rest of the country.  While law makers are devising regulations and laws enforcing EHR use and metrics recording, doctors are saying enough. According to a survey on SERMO 97% of doctors polled felt that medical licenses should not be tied to compliance with meaningful use requirements.

EHR technology has great potential, but most doctors don’t feel the technology is meaningful or an effective as a tool in patient care. This fact alone makes tying our medical licenses to compliance with the requirements absurd. One internist wrote “ I have had the opportunity to use multiple EMRs through my residency and fellowship training. My feelings are:

1. they always slowed me down
2. took my attention away from patients and their issues/questions
3. often confused me on what medications the patient was on when multiple people could input medications
4. found the diagnoses were often confusing for the same reason as #3. EMRs should not be mandatory for physicians who provide efficient and quality care for their patients.”

According to one urologist: “Physician productivity and contact with patients is compromised. Physicians turn into coders and data entry clerks. The physicians I know who have worked with a certain EHR system are especially unhappy and frustrated.“

An ER doc went so far as to say, “EHR is a triumph of politics and cronyism over common sense. It is lining the pockets of those who are part of the new medical computer industry. It is antithetical to the art of medicine and will do nothing to improve the quality of medicine we practice.”

Not only do physicians find the EHR time-consuming and confusing, some have simply quit medicine because of it. One ER doctor said “The whole system is cumbersome, slow, and stupid to the point or surreality. I quit in October. Three other hospital staff members have also quit.”

EHR costs prohibitive

Cost is another big factor in EHR adoption. While it may not be difficult for hospitals and large healthcare systems to purchase pricey systems, it is wrecking havoc on small practices and private doctors. One ophthalmologist said, “We figured out the cost of EHR – extra staff to scan things, IT support and an amortization of the license. I would have had to increase my medicare volume by 30x to come out even.”

Overhead costs are soaring while our incomes are shrinking or at least remaining stagnant. It is difficult for already financially strained practices to meet this added expense.

While doctors object to purchasing and using inadequate EHR technology, they are more opposed to the meaningful use requirements recently imposed. Initially, it was set into place as a bonus program. Over a few years, the government is now rolling out penalties in reimbursement to doctors who fail to meet requirements. Politicians now tell us how to use EHRs to improve patient care with little physician input. Surely, doctors know more of what goes on in an exam room than our elected officials who are far more likely to be lawyers than doctors. As a result of reporting all these metrics, doctors are spending more time looking at their computer screens than with eye-to-eye contact with patients.

One orthopedist wrote, “EMR can’t replace the back-and-forth of an exam. Checking boxes is not the same as a hand-written notation such as the patient likes to crochet and likes the color blue (for whatever reason).” We are losing this personal knowledge of our patients by computerizing them. A Clinical Medicine lab specialist goes on to say, “Patient care is not just a science…it’s an ART. For the Art part, it has to be an up-close and personal event; you just can’t fill in a form, follow an SOP and hope for the best.”

The criteria put forth does not reflect quality patient care in many doctors opinions. “An ophthalmologist stated, “MU requirements get tougher, and the work to keep up with them is extremely time-consuming. I doubt we will make it through this year’s Stage 2, Year 1. I made it through the others, but this one seems to be beyond me. Is there any evidence to support that EHRs improve patient care? They certainly don’t improve patient flow or satisfaction”.

Physician compensation is sometimes pinned to the absurd. According to an endocrinologist, “ You know what “meaningful use” means to me? Every visit with an infant, or child with diabetes, or hypothyroidism, or short stature begins with the phrase, “the government requires me to ask you if Johnny started smoking since your last visit.” And if I don’t ask, I am not in compliance and my ‘quality’ metric goes down.”

Some of these measures are not even in the control of the doctors required to report them. A urologist informed us, “the criteria are not necessarily based on patient care, especially as one current parameter is a certain percentage of patients have to contact you electronically. No one can control whether or not your patient:

1. has internet access
2. has an email address
3. knows how to use a portal system

It makes absolutely no sense to tie licensure to whether or not a physician follows all the MU use rules, especially since the rules keep changing.”

With all this, imagine how enraged doctors are to have their licenses tied to proper implementation and usage. An occupational medicine doctor writes, “State boards are usually tasked with assuring public safety. I in no way see this as a public safety issue and therefore it should not be within the scope of a state medical board.”

“Licensure is and should be linked to education, competence, and a commitment to maintaining one’s knowledge. I cannot agree with even the suggestion that issues related to record-keeping, no matter what it is used for, have any place in consideration of a professional license of any kind,” wrote one general surgeon.

While patients are feeling they are not getting enough time with their doctors, these mandates are prying us further from the human contact they need and want. EHRs are a time drain, far from improving patient care, they are making it more difficult.

Doctors Do Not Stand Alone

Doctors are not alone in their stance against medical licenses being tied to EHR use and compliance with the accompanying regulations. According to Ken Congdon, Editor in Chief of Health IT Outcomes, “Although I am a supporter of the MU program and what it is trying to accomplish, requiring a physician to adhere to MU (or HER use) or lose their license is ridiculous. While there are several benefits to using the technology effectively, many physicians will never be comfortable using the tool. Does this mean they should be forced out of practice? Absolutely not. However, over time, patients may demand the benefits EHR technology facilitates (e.g. health record access, care continuity, patient portal, etc.). However, a provider’s patient base should drive this adoption. The state or other government body should not enforce licenses this way. Just because a physician doesn’t use an EHR doesn’t mean they’re not a good physician or valued caregiver.”

While the potential of EHRs is tremendous, the technology as it currently stands is failing us. This intrusion is unwanted and is decreasing the value of healthcare. We should test mandates efficacy before we tie physicians’ licenses to them. They should meet quality tests and minimum levels of clinical usefulness. We do not feel EHRs improve patient care, but rather they erode the doctor/patient relationship.

To mandate their use at this stage is ludicrous. To tie it to our medical licenses is insulting. There is no way a doctor’s competency could or should be determined by their ability to use an EHR or to compliantly check metric boxes.

Does anyone truly want a doctor whose quality is determined by their data entry skills? Patients deserve caring, astute doctors in exam rooms, delivering the best treatment options. Let’s focus on giving them the best of our knowledge and experience, not our secretarial skills.

Bio

Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University, UMDNJ, and other institutions.  Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University.  She has appeared in US News and on NBC Nightly News.

The post EHRs Tied to Physicians’ Licenses: A Bad Idea appeared first on Sermo.