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The US National Medical Record Disaster

Good Intentions Run amuck just like Current US Healthcare

Doctors, with the help of insurance companies, businessmen, efficiency experts, and drug companies have destroyed US healthcare.

On the surface, a digital national healthcare system, such as that proposed by President Obama, seems an ideal way to capitalize on individual patient experience with their doctors and better coordinate their healthcare among doctors. Because we grow up believing that those people in the white coats rate just below Jesus when it comes to healing and protecting us, we place our trust in them and rarely question their opinions or actions. However, for those of us who have suffered serious health problems and have had to deal with doctors and our healthcare system, this image is soon shattered and we quickly learn that some doctors are incompetent, unethical, emotionally unfit, and can cause more harm than good. Indeed, many US doctors spend their lives causing injuries and endangering their patients' lives. Add to this the dangers of many of our medications and their misuse and we wonder if "healthcare" is really an appropriate label.

Facts:
* US healthcare quality is rated lower than that of all other modern countries
* US healthcare is far more expensive than that of all modern countries
* In the US, each year more people are killed by doctor errors than by auto accidents. I won't elaborate, for many books have been written about the reckless practice of medicine in the US and the misery it causes.

Following is an excerpt from one such book where the doctor-author describes many such errors, including those related to his own care by fellow doctors:

I do have the advantage of lots of experience upon which to base my opinions. Simple doctor errors have caused me years of unnecessary misery, permanent disabilities, and expense.

Patient Records:

Scary as it sounds, doctors, nurses, and office clerks are solely responsible for the information included in patient records and computerized healthcare systems. More scary is the fact that once a doctor's thoughts are documented and computerized, they take on the quality of scientific information, despite the fact that the information is often based upon guesswork, dishonesty, and input error. Though it might be a "medical record," the only thing truly scientific about it is the design and function of the computer systems. With their built in programming errors, of course.

Experience is the best teacher:

For several years, I periodically suffered flu-like symptoms and ran a slight fever, usually just under 100 degrees F. I complained to several doctors about this. One doctor said, "I don't consider anything 100 degrees or less a fever"and did nothing except charge me for the five minute visit. Other doctors suggested I might have a touch of the flu and ignored it. With no effort to diagnose the problem, one simply prescribed antibiotics. I did not believe I was receiving proper care, so continued to seek help, which of course can make one unpopular in the medical community. I told my new doctor about my symptoms and she ordered a barium exam of my system. Yuck! At the end of my exam, the technician showed me the scans, which revealed numerous large diverticulums that were infected. My doctor followed up by referring me to a gastroenterologist who then referred me to a surgeon, who subsequently performed a resection of my sigmoid colon. I've never had this problem since. 

Today, my medical records include comments of the all the doctors from whom I sought help for this problem, including those who misdiagnosed my problem plus those who actually did their job. It might go like this: Doctor #1. Patient complains of slight fever. I informed him that I did not consider his temperature a problem. No action. Doctor #2. Patient complains of flu-like symptoms. I prescribed antibiotics. Doctor #3. Patient complains of flu-like symptoms. I ordered barium exam. Tests positive for diverticulitis. Referred to gastroenterologist who recommended surgery. Surgeon performed resection of colon. Patient reports significant improvement. No more fevers.

Medical Record Inaccuracies:

The basic problem with computerized medical records is that they are highly inaccurate for several reasons. Besides the flagrant doctor errors, doctors are not the only people who have access to and can change patient records. Receptionists, office clerks, and nurses all have access to patient files and can input and change information--without the doctor's approval. At one of my doctors' offices, the receptionist and I discovered that my patient file had my name as Walter rather than Wayne. We chuckled and the receptionist simply changed the name on the file. What other similar errors might we find?

Misdiagnoses:

Perhaps the most serious problem with computerized healthcare records is the unbelievable high rate of misdiagnosis and inappropriate use of drugs. Few doctors take advantage of the diagnostic tools available to them and prefer to increase profits for their group's business by simply guessing. A money hungry neurologist can spend fifteen minutes doing some cursory nerve testing and charge $600. While another can spend an hour doing more extensive testing and still charge $600. Most doctors are business partners with other doctors, where productivity and contribution are judged by their partners. A doctor I had been seeing for a number of years abruptly retired while still in his 50's. I talked with him one day and he told me. "I quit because all my partners were interested in was money."

Second Opinions:

Most patients who have suffered serious illness value their option of obtaining a second opinion. This has gained lots of press lately regarding the diagnoses of "breast cancer," where opinions among doctors and lab workers vary widely. However, with modern medicine, obtaining an unbiased second opinion is almost impossible since the business managers and efficiency experts have taken over our healthcare system. In some small cities, like Wenatchee, Washington or Eugene, Oregon, the majority of doctors might work for one clinic. Where I live, most cardiologists work together in one group. Same for orthopedic surgeons, urologists, surgeons, etc. In such cases, patient records are shared by all clerks, nurses, and doctors. Because doctor networks are tied together for easy referrals, seeing one doctor can result in the patient's records being shared by dozens of other people.

With this modern, well managed, efficient, computerized medical record system, when a patient does not feel he is receiving proper care or disagrees with his doctor's diagnoses, how does he obtain an unbiased second opinion? Going to a different doctor in the same group results in his or her reviewing their fellow doctors' diagnoses and treatment, which can seriously bias their own efforts. In dealing with my own health problems, on two occasions I have had to seek second opinions from doctors in other cities. In both cases, the testing and diagnoses were totally contrary to the biased opinions of my home doctors.

For doctors who are able to be objective and honest, working in groups can be a great advantage. When I was not satisfied by two doctors in my home town, I traveled to a city a few hours away to seek a second opinion for neurological problems. After my visit, the surgeon wrote to tell me that because of the complexity of my problems, he had reviewed my case with each of his office partners. They did not have access to the records of my two previous doctors. It was their collective opinion that I could benefit from spinal surgery.

Patient records should not be shared within groups without his or her permission. In cases where most specialists in a city work in one large group, when a patient disagrees with the doctor and wants an unbiased opinion of one of his partners, the new doctor should not have access to previous records.This is no different from when doctors worked independently. The current system operates as if the practice of medicine were a science and sharing information is an advantage. Anyone with experience, including doctors, knows this is totally wrong. Doctors can be ill trained, incompetent, make poor guesses, and simply succumb to human error. The people who pay the price, often with their lives, are the patients.

Efficiency experts move from manufacturing plants to doctors' offices:

Henry Ford became famous when efficiency experts broke down the assembly of his cars into a series of small operations. Because the time to assemble a car was significantly reduced, thus increasing output while reducing cost, this was seen as a great success. Unfortunately, just as in most industries and now in doctors' offices, managers and efficiency experts do not consider the effect they are having on the individual workers, who are ultimately the consumers. Watch the videos of Henry Ford's assembly line workers and notice the unbearably monotonous simple operations each worker must perform for ten and twelve hours a day. Think about the original method where each worker performed multiple jobs. A few people could assemble the whole car and think of the pride when they started it up and drove it out the door. However, as usual, Wall Street won while the workers lost. 

Efficiency experts take over doctor offices:

It is quite easy for efficiency experts to recognize that the only time a doctor's training and skills are required is during the diagnosing and treatment of health problems. Everything else can be done by clerks and nurses. By reducing the doctor's work to only that which is essential (by law) he or she can see many more patients per day, thus increasing their group's profits. Introducing additional people into the process of talking with the patient, recording his or her comments, passing this on to the doctor, etc., requires a high level of organization and management and this is the reason why the Office Mangers have become so important in medical offices. Just as in any business, the more people involved the lower the overall skill level, the exposure to errors increases. Any patient who reviews their medical records might discover inaccuracies. With so many people having access and authority to change the records, where did these inaccuracies come from?

Doctor-Patient relationship:

Most important for the doctor and his patient in the "patient-doctor relationship." Smart doctors know that if they will listen, the patient will almost diagnose his or her own problems. However, those days are gone for many doctors. When I phone and make an appointment to see a doctor, the clerk asks me why I need to see a doctor. This sort of irritates me because she is a clerk and I would prefer to tell my doctor about my problems. Though I might really know what's wrong with me, the clerk inputs my response into the computer system. When I get to the doctor's office for my appointment, the receptionist asks again why I am seeing the doctor today and changes my medical record to her satisfaction. After I am escorted to an exam room, a nurse usually asks again why I am seeing the doctor today. Once more I offer my opinions about what's bothering me and she revises my records as she sees fit.

Prior to coming in to see me, the doctor has reviewed what the clerks and nurses have written about the purpose of my visit, thus reducing the amount of time he need spend talking with me. The problem of course is that a barrier of non-doctor and computers has been erected between the doctor and his patient. Good for business; lousy for the doctor and his patient.

The latest absurdity with which to increase efficiency that I have experienced is that the doctor no longer makes his own notes or dictates his discussion with his patient. Instead, I assume it is a nurse who joins the doctor and patient in the exam room and types the conversation into the computer, thus offering the typist's interpretation and opinions about what is going on. On a couple occasions I have reviewed what was typed and entered into my records and have discovered gross errors.

Legalities:

Unlike handwritten doctor notes of long ago, current computer records can be changed at any time by the office staff, nurses, or the doctor. And the computer input forms do not include a place to document who made the change, when they were made, or why. The legal implications are that medical record information can be changed at any time.

A great problem with medical records is that they sometimes do not reflect the interaction between the patient and his doctor. This is a very serious problem because many doctors talk one way to the patient and totally differently when recording their discussion. Many patients are surprised when they review their records and learn what their doctors have written about them and realize why they have been unable get help from other doctors. Which leads to my next point.

Despite their errors, DOCTORS STICK TOGETHER IN A NICE BUDDY SYSTEM WHERE SUPPORTING ONE ANOTHER IS OF PRIMARY IMPORTANCE. If one doctor at a clinic where patient files are shared screws up, which is usually the case, other doctors are highly biased by the opinions of their partners. It saves them time and won't cause their buddies embarrassment. I suppose it also helps during lawsuits. After five doctors at Wenatchee Valley Clinic followed the lead and echoed the misdiagnosis of an incompetent neurologist, I filed a complaint with the Washington State Health Department. The doctors stuck together and the DOCTOR who investigated my complaint concluded that I had been a "difficult patient." Interesting, for it all started when I told the first neurologist that I had previously been diagnosed with seizures and that they were become severe. Without benefit of an inexpensive and quick EEG test, he took a guess and told me I was not having seizures, but panic attacks. Ridiculous, for the symptoms are totally different. Though all these doctors had made very serious errors, they were all comforted by their buddy system.

Shifting responsibility to he patient:

Pharmaceuticals:

The main purpose of TV in the US is to market prescription drugs. What do we get for the high fees we pay our cable companies? Two or three minutes of news followed by six or seven dangerous pharmaceutical advertisements. Each ad is followed by the legal disclaimers: Tell you doctor if you have liver problems, etc. I would like to know, unless my doctor has so advised me, how the hell do I know if I have liver problems? Doesn't matter, for this is just a method of shifting the responsibility of the drugs dangers away from the pharmaceutical company. No matter how dangerous the drug, if its dangers are stated on the label and in the advertising, the patient becomes responsible. Doesn't matter that the patient can't read or hasn't the faintest idea what all this gibberish is about. I mean, what is a liver anyway?

Medical Record Legal Nonsense:

Each time a patient visits his or her doctor, they are required to fill out forms with checklists about their medical history. Do you have liver problems, have you had cancer, are you mentally ill, do you have kidney problems, etc., etc. Unless problems have been previously diagnosed, how is the patient supposed to know? Mental illness? What is this? Even if a patient has been previously diagnosed with "mental illness," why would he or she want to tell everyone in the doctor's office about it? Very important here is the recklessness with which some doctors label people as "mentally ill." If a patient has never been diagnosed as "mentally ill," how can he be expected to know whether he is mentally ill or not.

Pharmaceutical ads and medical records are studied by attorneys who include these disclaimers, that place all the responsibility onto the patient, and preclude lawsuits against drug companies and the doctors. How can the drug company be held responsible when in their TV commercial they ended with someone in a bland voice listing all the dangers and advising the patient to see his doctor? How can the doctor be responsible for misdiagnosing a liver problem when the patient checked the box on the form that says he doesn't have liver problem.

I recently read the records for one of my doctor visits. There was a sheet with a long list of my denials:

Patient denies kidney problems
Patient denies liver problems
Patient denies mental illness

Really? I don't recall denying anything. If asked if I have liver problems and given the choice, Yes or No, I am going to choose no--simply because no doctor has ever told me I have liver problems and because I haven't the faintest idea. These forms should include a box to check for "I don't know."

These forms usually ask if I have had mental illness, suffered paranoia, suicidal thoughts, etc. First of all, when it comes to mental health, though everyone is on the continuum for most defined "illnesses," only a small percent have ever sought help. More importantly, a very small percent have been properly diagnosed. Due to the many psychological, psychiatric, and quack theories, plus the high variation in training and competency among so called "therapists," such questions have little or no scientific value. If I am seeing my urologist or proctologist, of what relevance are my answers to these questions. Haven't all people had "suicidal thoughts" at some time in their life? Haven't all people felt a bit "paranoid" at some time in their life? Answering yes to any of these "mental health" questions can easily be misconstrued by doctors, most of whom have little competency in this field. Consider the implication during lawsuits when attorneys and government agents gain access to patient records.

US Government and Corporate access to patient medical records:

Given the willingness of the US Government to ignore the US Constitution and our Civil Rights, it should be obvious that US intelligence agents and corporate spies will have their noses in our national medical record system. Bush had 3,000 NSA agents illegally monitoring overseas phone calls. For eight years the US Government has illegally had me under surveillance, hacked into my computers, and tapped my phone lines, and spied on me. Why would I expect them not to examine my health records.

Patient Rights:

Most patients are unaware of the errors that exist in their medical records and that they have the right to examine their records and voice their disagreements. Those who do examine their records are often shocked by what the doctors and nurses have written about them. 

Most doctors' offices are already linked together for sharing of patient records. If a patient has several doctors and has signed release forms, his or her records are visible to a dozen or more doctors, nurses, and office staff members. If a patient has four or five doctors, perhaps fifteen or twenty people in a small town will have access to his medical records and personal information. If all these people have access to a patient's medical records, why shouldn't the patient?

All patients should have access to their medical records via the Internet. They should have the right to record their opinions and disagreements, which should become part of the record and not kept in a separate file.

The quality of US healthcare rates very poorly when compared with other countries and I feel the reasons are quite obvious. EU doctors work for their governments and its people, while those in the US work for their business groups and profits. Medical offices in EU countries are not overburdened by business managers, efficiency experts, office clerks, and computer systems. Most importantly, business and efficiency experts do not define the doctors' job, forcing them to capitalize on "doctor time," as described above.

Our Republican Congressmen can crow all they want about America's superior healthcare system. However, as with most issues, they have sold their souls and do not represent the American people per the Constitution, but the interests of their corporate sponsors.

The greatest health related experience in my life occurred when I became seriously ill while in Italy. I was so ill that an associate took me to the Emergency Hospital. It was an amazing experience. No billing clerks, no computers and masses of wires, and no forms to fill out. One nurse received each incoming patient and coordinated the activities. After copying my passport and making a few notes about my symptoms, he told me to have a seat. Within ten minutes I was greeted by a nurse who invited me to an exam room and stayed with me and worked with a doctor who examined me. She did not question me or waste time staring at a computer monitor and punching punching keys. Likewise, the doctor did not waste time staring at a computer monitor and punching keys, but instead talked with me, the patient. Between the two of them, they did an extensive exam that included drawing blood samples and ordering X-rays. After the doctor reviewed the x-rays, he referred me to the Pneumonia Clinic, where I was examined by another doctor. Because my eyes were inflamed, I was then referred to the Ophthalmology Clinic where I was examined and treated by a third doctor. By the time I was ready to leave, I dreaded seeing the bill. However, the nurse who had checked me in reviewed my x-rays, lab report and the doctors' handwritten notes. He then handed the package containing copies of all my records and warmheartedly wished me well. Like all Americans I know who have sought medical help in Italy, my medical services were free. Can you imagine an Italian coming to the US and receiving such care?

I recently talked with a woman who became ill while traveling in Canada. For her doctor visit there, she was charged $10. Can you imagine a Canadian coming here and receiving such care?

The EU experience is quite a contrast to that of America where even the most desperately poor citizens are refused medical help by cold-hearted Republicans and their corporate sponsors. Doctors are not exempt from responsibility, for they participate by dedicating their efforts to their business groups. I am aware that some doctors dedicate their time to special clinics that provide free or reduced cost service for the poor.

Summary: Computerized medical records are already a disaster due to the high rate of doctor and clerical errors. A national medical record system would create an even larger disaster by amplifying the already serious healthcare problems in the US. The greatest single problem is that shared medical systems create health records that are often full of errors and preclude the patient's ability to find independent, unbiased healthcare. When a patient cannot receive what he feels is proper care from one doctor, or a doctor group, he or she should be able to start fresh with a new doctor who is not biased by the opinions of previous doctors. Unless it is necessary for continued care for a particular illness, doctors should not be allowed to review previous doctor records, which is often counterproductive and can lead to great error and injustice.

Proceed

Published: 16 July 2010
Revised:    21 July 2010

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