Monday, February 23, 2009

Feeling a little old

This past weekend, I started working as a hospitalist, with the goal of working about one weekend per month. I chose to do this to maintain this unique set of skills which I worked very hard in residency to obtain, to see different problems from the ones I see in my outpatient clinic, and to spend some time with other pediatricians. As I was hoping, it was a lot of fun, and it was interesting to see the variety of patients on the pediatric floor. Of course the majority of patients had respiratory problems, it being winter, but even among them, there was some variety. I found my sea legs fairly quickly, to my great relief.

I did feel a bit out of touch, however, like I had been passed by father time. When I did my residency, which was not very long ago, we had some parts of the medical record computerized; we were able to look up lab and radiology results online. Every morning, all of us had to walk around the wards, finding nursing notes with vitals, finding charts to write in, and signing verbal orders. This was a great time to check in with patients, parents, and most importantly, nursing, but it was certainly tedious and inefficient! At the hospital where I worked this weekend, most of the medical record has been computerized, and they are in the process of making the ordering process electronic. Needless to say, I was very excited and intrigued to try this new system! It was wonderful to have access to labs, radiology, dictations, and nursing notes on the computer, and actually, on any computer with internet access! What a change! I was pretty slow at using the system since it was brand new to me, but I'm sure that I'll get used to it. But, what was shocking to me was that I missed walking around looking at paper vital signs flow sheets... I was able to talk to the nurses and patients, but it was just different, a little less social. Some aspects were much better, like the graphs with the fever curve and computer-calculated ins/outs which eliminate relying on my math skills (a positive), and the previously hand-written narratives which were now legible! Yet, it made me feel a little old that I missed the old paper system. I can't imagine what it would be like for someone to learn this system without any experience with electronic records! Obviously, electronic health records are the future (in some places, the present!), and this change will likely change the medical culture, just as mp3s have changed the music culture. And, I suspect, just like LPs have a strong following even now in 2009, I suspect paper charts will have a strong following in 2020, but I, for one, will be relieved when I get EMRs in my office and the hospital EMR continues to progress.

I found an amazing video on YouTube from 1966 that I posted on my next blog. Please check it out!

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