Saturday, September 18, 2010

Patients ? or Paperwork ?

For most good doctors, taking good care of patients means just that - providing high quality clinical care, so patients get better sooner. While they understand that it's important to keep good quality medical records, they are much more focussed on meeting the patient's human needs by holding their hand; talking to them ; providing emotional support ; and counselling. Most good doctors would rather spend time talking to the patient, rather than filling up a form. And this is true of patients as well - they want doctors who will spend time with them, rather than with a form.

For most outsiders, however, who do not understand much about medicine, sadly the paperwork is far important than the quality of the care actually provided to the patient.

This is true because of many reasons. For one, non-clinicians are not doctors, and do not understand much about medicine or clinical care. All they understand is paperwork and forms - and therefore will judge the doctor's activities by the only metric they can measure - the paperwork !

For most bureaucrats , the only thing they are good at handling is papers, which is why medical records become so important to them . Similarly, from a lawyer's point of view, if a particular action was not documented, this means it was not done , which is why they believe that the best protection against a lawsuit for medical negligence is not good quality medical care, but a well-kept medical record ! This is true for health insurance companies as well, who will provide reimbursement based on how well the "patient encounter" has been coded by the billing clerk - and not by the time the doctor spent with the patient; or how happy the patient is with the doctor ! ( After all, you cannot measure this, so why bother ?) But, as Einstein said, not everything which can be measured is important - and not everything which is important can be measured !

For government officials as well , paperwork is far more important than patient care. In fact, in India , not keeping proper records is considered to be a criminal offence under the PNDT Act ! If a doctor does not fill in the Form F properly, this means that he is indulging in female feticide and should be jailed !

The tragedy is that this focus on the paperwork means that doctors have much less time to spend with their patients. Doctors will now spend more time checking off boxes on a paper form - or glued to a computer screen, filling in data. They will lose eye contact - and thus the chance to establish an emotional rapport with the patient or display empathy ! What a shame !

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