DOCtalk by Dr. Gregg 7/28/12

Days of Whine and Proses

In the midst of just another day of too many patients with far too many unexpected problems squeezed into far too few time slots within which were too few moments to reflect and consider, I had an epiphany: I, we, all of us in healthcare delivery are living in the midst of the Days of Whine and Proses.

The Whine? We are still, as I said several years back, in the very midst of the birth pangs of the delivery of this huge "enfant terrible" known as digital healthcare. We are whining about the fact that this infant was ever conceived, we’re whining about the cramps, and we’re whining about the lack of an epidural equivalent.

We whine because it costs us money. We whine because it costs us time. We whine because it invades our processes. We whine because it intrudes upon our interactions.

We whine when it doesn’t work at all, when it doesn’t work correctly, or when it just doesn’t work exactly the way we want it to. We whine when it is less than perfect even when we don’t really have a true reference for just what such perfection is.

We whine because it is different from what we know.

On this particular day, I found myself in the midst of an unspoken internal whine about a merely tangential HIT issue. I had just realized that all of the prose I was "prosing" as I attempted to document by point or by click, by dropdown or by pop-up, by two-fingered typing or by fat-fingered falter was fairly futile.

My whine wasn’t just bemoaning the fact that the process of digitization of my thought processes was far from an enjoyable experience. And, it wasn’t a whine about the less than optimal ergonomics still involved in mental to machine interpolation.

No, within the soundproof walls of my internal mental monologue was a whine about all of the prose I was digitizing for near eternal salvation to be forever lost within the silent world of HIT Neverland.

Think about it. We spend hours each week away from our families and friends, away from the actual act of caring for the health of our patients (or ourselves), away from sleep or supper just to document items and issues with details, many of which, if not most of which, will never be read by anyone, ever.

Every single provider, every one of us, whether digitally or pen-and-paperly, spends countless portions of our working lives documenting things large and small which will never be noted by another human being as having ever been so documented.

Nobody is ever going to read virtually any of the hundreds of thousands of times I’ve written (or clicked) that a tympanic membrane was clear. Few will ever note any of the tens of thousands of exudative pharyngeal tonsils I’ve documented. Only rarely will anyone ever notice any of the thousands of soft systolic heart murmurs heard over all of those left sternal borders that I so meticulously marked down.

I realize that all of those pertinent negatives and their typically more glamorous counterparts, the pertinent positives, are important to note and to note down. But, just thinking about how many numbers and letters and words and phrases I have documented over the years which no one will ever, ever read and then multiplying that by the millions of healthcare providers across the globe who are doing similarly, I found a whine I had never before considered – that is, we are generating billions, maybe trillions, of these precious pieces of pertinent prose for the purpose of… what?

If a tree falls in the woods and no one is around to hear, does it make a sound?

If a documented finding is never read again, was the documentation of that finding worth the time it took to document? Is the disk space it consumes worth the electromagnetic energy it takes to maintain it?

I’m not even thinking about the appropriate answers to those rather rhetorical queries. I’m just whining… whining about all the prose, all the prose that nowhere goes, here in the Days of Whine and Proses.

From the trenches…

“This is the way I look when I’m sober. It’s enough to make a person drink, wouldn’t you say?” – Kirsten Arnesen Clay in Days of Wine and Roses, 1962

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).