Out with the egos, in with EMRs and improving quality of care

One of the secrets I finally figured out about two months ago that led to my eventually throwing off the chains of evening charting and enjoying more of my life outside the office (REALLY?! you might ask if you’re a doctor) is the use of templates in the “History of Present Illness” section of my notes.  Efficient chart documentation that is done by the end of each patient’s visit is what resulted.  The History of Present Illness, or HPI, is the largest section of documentation and is the most specific section of an office note to the patient’s story.  It is the patient’s story.

I had never templated an HPI before this, mainly owing to backwards thinking that it really could not, or should not, be done.  After all, I had trained at the world-famous Johns Hopkins Hospital.  It would be the last thing that separated me as a snooty “real” doctor, walking on water, from a midlevel provider (PA, NP, etc) with not nearly the level of education and experience that would give them the capability of generating a note comparable with a great work of art.  With this final step of using templates in the HPI, my transformation to the Dark Side would be truly complete.

This feeling of superiority, that a “real” doctor can extract all the most important uniqueness of a given patient from the interview, and that somehow this all matters to the patient’s care, is pervasive in medicine.  And so templating an HPI section is anathema.  It’s tantamount to sacrelidge.  And now as I think back, completely a load of jelly beans!  No one stops to think why they have been trained to feel this way.  As an industry insider, I see it all the time in the notes I read dictated by older physicians.

So one fateful day, I thought I would give templating the HPI section a try.  Before I knew it, it made my approach to patients much more uniform.  Less questions that should be asked to all diabetics, thyroid patients, and men with low testosterone were being forgotten.  Templating makes it impossible to forget because the macro is right there on the computer screen, forcing you to ask all the important questions.  My patients now get better care because I miss less on busy days when I’m a bit more harried due to all the phone calls, prescription refills, and  other paper pushing that doctors need to do besides simply seeing their patients.  As far as the Dark Side goes, I wish more people would join me over here.  Darth Vader actually does a great job and gets to unwind after hours, too.

 

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.  He can be reached at doctorwestindc@gmail.com.

About the author

Dr. Michael West

Dr. Michael West

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

3 Comments

  • Michael, I can’t help but laugh at this one. Nicely written.

    For what it’s worth, I’ve built countless templates for MDs at the venerable institution where you trained, and a few of the docs even reached the same conclusion that you did. There’s also an article in the 5/2007 issue of Dermatologic Surgery (Vol 33 Issue 5 “Electronic Templates versus Dictation for the Completion of Mohs Micrographic Surgery Operative Notes”) that was written by a bunch of Hopkins people. It’s not specifically on HPI, but you might find it interesting.

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