To Click or Not to Click

Craig Joseph, MD
By: Craig Joseph, MD
Date: December 06, 2018

I have to admit that doctors often confuse me. Now I know, if you’re a regular reader of mine, you might think that’s odd because . . . I am a doctor. Yet still, sometimes my colleagues do things that I cannot explain. Because I focus on the cross section between technology and medicine, you can reasonably predict that I’m not going to be writing about why doctors choose a foreign car versus a domestic one. Nope, I want to deal with doctors and their habit of mouse clicking when no mouse click is needed.

Let me first establish that doctors are, on the whole, pretty smart people. It’s not easy to get into medical school. You’ve got to be good at taking tests. It used to be that you had to be very, very good at regurgitating memorized data back to professors, but hopefully that’s changing (at least I’m told that’s changing.) Check: doctors are intelligent.

Further, it has been my experience that doctors are trained to be . . . curious. Maybe a better word is inquisitive. Oh, let me just write it: people tell us a lot of stuff that turns out to be untrue. Or half true. Or true but in need of context. As a resident physician in the ED of a busy children’s hospital, I had a teenager swear to me that she couldn’t be pregnant because she was a virgin; she was pregnant. I’ve had a panicked lab analyst call me with a blood result indicating that my very-much-alive patient was dead; she was alive, while the lab result was wrong. After reading the nursing and anesthesia notes that indicated the patient had no allergies, the very same patient told me, “Oh, yeah, I forgot; I’m allergic to sulfa. Is that important?”

Trust, but verify. Don’t take anything at face value. If information doesn’t make sense or fit into the expected pattern, question it. Probe it. It may very well be that you’ve been told the truth, but if it smells weird, don’t just believe it. We doctors do this all the time, usually without even thinking about it. Yet somehow things change when it comes to using the electronic health record (EHR).

I see so many physicians check a box because . . . it’s a box, and surely it must be checked. When I ask them why they’re checking a box that doesn’t necessarily need to be addressed, I get answers like “I thought I couldn’t finish the documentation unless all the white space was filled in” or “Someone told me once that the billers needed that information.” These are the same doctors who question patient histories and lab results and consultants’ recommendations every single day, yet they often just click and type useless (or at least not relevant) information into the EHR for questionable reasons or no reasons at all.

Some doctors who are reading this are yelling at their phone, tablet, or computer monitor right now. Here’s what they’re screaming: “Are you kidding me? Have you never dealt with our compliance people or coders or lawyers? They’ve got me re-typing information that my MA just entered. Not copying and pasting, mind you: re-typing. They say it’s the law. And now you’ve got the gall to wonder aloud why we assume every box needs to be checked. I’m coming for you, Joseph! Run!”

I’d be foolish to disagree with this line of reasoning. So much of what physicians must do in the United States makes no sense. We document crazy things to appease billers or coders. We worry about getting sued for malpractice, hence we order tests and note irrelevant information so we can prove we considered highly unlikely causes. We re-type what our assistant just entered because some outdated, strictly-interpreted regulation says we must (that regulation is changing next year, for what it’s worth – thanks, CMS!)

I admit that we physicians have been beaten down by The Man. I get it. And I acknowledge that often in healthcare IT, we are thought to be The Man. It’s true that technology can be used to enforce the rules. I can’t help that. But sometimes, poor EHR design or just unfounded user assumptions serve to double-down on that beaten-down feeling.

What’s the cure? From the HIT perspective, I encourage physicians to question their clinical and IT leadership. Why is this box here if I’m not expected to enter anything in it? Why is this a required field when I didn’t need to go to medical school to address it? Why does my workflow include data that I don’t need to care for my patients? These are fair questions to ask. If you ask them, you might find that you’re doing work that just doesn’t need to be done!

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