Tuesday, March 12, 2013

Reading Charts

Pet Peeve Time

My medical professors and senior residents trained me well.  I may not have liked it at the time, but they were insistent that I review old records when a patient was assigned to me.  Records were kept on paper with tabs for the various types of entries.  They would come up in a big basket, often with multiple volumes, and have the approximate appearance of a telephone directory from  a large city.  On the front of each admission would be a transcribed discharge summary which provided mostly useful information but occasionally became the source for propagated misinformation from one hospitalization to the next.  The specialists tended to go beyond discharge summaries,  needing to look at trends in lab data over time so I got very proficient at reviewing where the CBC's and creatinines had been the last few years.  Serial radiologic studies were more difficult to assess so a trip to the X-Ray File Room would be part of the chart review much of the time.

Computerization of records has made the review much easier.  Instead of having to go through each lab section of each admission, trends are now tabulated across admissions.  All the summaries are presented serially, all the X-Rays are presented in sequence, both images and reports.  This seems like a snap for those of us who once had to hunt for what we need but at least know what we need.  The amount of time spent doing these reviews probably has not changed much but the amount learned about the patient in that time has expanded enormously.  It helps, though, to know what you are looking for, a skill better developed by having to very selectively seeking out prior data from amid a multivolume record.

Many of my residents never acquired that skill.  They process through a new patient without ever looking at primary data from the past.  Summaries get propagated forward, misinformation with the correct diagnoses as a bundle.  But review of trends invariably comes from the consultants.  While this type of review is labor intensive, it is not that labor intensive.  And what might they be doing instead?  And why go through all the trouble of doing this if the patient will be handed off to somebody else in a day or two?  There is really no ownership of the patients, maybe not even stewardship.

So for now I have a useful but skill but one of diminishing interest.  I know how to use a stethoscope and slide rule too.

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