Friday, April 15, 2016


    When the EMR , or electronic Medical records were introduced , it was thought that we will have better care. In fact the federal government paid physicians to participate in it . So many physicians got it. Those like myself who did not participate in it got reduced payments for the services than those who did get EMR . So now that we have it is the quality improved? In my estimate it has not only not improved , but has gotten worst. In the hospitals we HAVE to do EMR and I spend at least one and half hour extra doing it . On top of that I often see more things in the records than actually has been done .
    I get notes from other physicians . Many of them are 6 pages . When I go through them I find that 4 new lines , every thing else is same as was in previous last 5 notes . This is due to EMR. The notes are Generated by the computer and the physicians pit in minimal new information and rest is carried from old note which was generated on first visit. In one of the notes one physician who started labeling problems with alphabets rather than numerical numbers, at the end of the note he ran out of the alphabets and had to label AA,BB etc. Were there more than 26 problems that this physician addressed in 15 minutes visit? But the reason I am writing this today is due to one of the patients that I saw .
     I was consulted on this 48 years old patient for the diagnosis pf pneumonia . He had no fever , no t much cough , but the cheat X-ray showed some congestion. So he was started on antibiotics and I was asked to see him.He also had low blood count and so a blood doctor was also consulted. He had also history of heart disease and so a cardiologist was also asked to see him . I saw the patient . He had history of a disease called sarcoidosis and when I asked him as to how it was diagnosed , he told me that he had 'OPEN LUNG BIOPSY' . When I examined him . he had big belly. On examination he had enlarged liver and spleen and had fluid in belly. I had ordered CT scan of the chest and the Ultrasound of the belly. The CT scan showed that he did NOT have pneumonia and the mild congestion that was seen on plain chest x-ray was related to previous lung biopsy . The ultrasound of the abdomen DID show that he had cirrhosis of the liver and enlarged spleen and fluid .
    I did some further investigations. I called gastroenterologist and told the patient and his wife that he will need to see a liver specialist for consideration of liver transplant .
    I went back and looked at the EMR entries of one hospital doctor 3 different blood doctors and one cardiologist . EVERYONE had put belly examination as NORMAL on several different times . Some of these entries were done AFTER we had the US report showing enlarged liver and spleen . This the ' EMR and CUT and PASTE notes .   

Saturday, April 9, 2016


    In medicine as in any other field we all are product of advertisement. Every one today is concerned about cholesterol , even a 80 years old patient who has end stage lung disease and controlling the cholesterol would make no difference in his shortness of breathing for sure and probably in his survival. But he continues to be given statins and he also spends lot of money for the medicines that I am not sure is going to help. I would like to have someone do a study on these kind of patients who have significant co morbidity or are very old , to see if lowering cholesterol is beneficial or not. But then there is no benefit in doing this study for the pharmaceutical companies. But then there are known killers and we pay no attentions. This is primarily due to media bias. The two most common disease get attention in media are heart disease and breast cancer . But then there is no excitement in Influenza. That is what I am talking today .
    The flu is common and most of the people do not  need or seek treatment and get better. But then physician like me see the sick ones and some get so sick that they are in intensive care unit and even die.
    It was 6-30 pm and I was about finished with my patients and I had couple of notes to be finished . So I was happy . Then I got a call from one of the hospital doctors, asking me if I could see a new patient who was 'sick'. It was a27 years old Hispanic patient who had her first delivery and was found to have low oxygen and so this hospital doctor was asked to see her . In tern he asked me to see her . They had thought about some unusual conditions like amniotic fluid embolism. In this condition at the time of delivery the fluid from the sack enters the mother's blood and gets in lung and causes all sorts of problem . The bad part is that there is no real treatment. So I went to see her . When I saw her she not complaining of shortness of breath or any chest pain. Her respiratory rate was high and her oxygen saturation was low . Her lungs were congested and her chest X-ray was bad . It showed pneumonia . In this young lady who had just delivered a baby , I thought of vomiting and aspiration . But then there was no history of vomiting .She was in ER day before with symptoms of cold or flu and had 'rapid flu test' . It was negative and so she was sent home . Her history was suggestive of flu . So I started her on treatment and called infection specialist. I also transferred her to ICU . I was worried about the pneumonia and flu causing respiratory failure. I was right and she did get worse . There was no embolism. She was in ICU for 4 or 5 days . needed high flow oxygen. But she slowly got better and after in the hospital for 10 days she was sent home.
   So flu almost killed this lady. But with shear luck she got better . Recently I have had 2 more otherwise healthy patients in ICU and needed to be in the hospital foe 12-14 days. I also heard of 35 years old male loosing life due to flu.