Tuesday, January 17, 2017

#7: The Never Ending Prescription

Dear Dr. Tumoriffic,

Why does it take so long to update my med list in the EMR? I haven't taken that med for 5 years.


Dear Liz,

The reason is that your medical record is constipated. Clearly, it has not been eating enough fiber. Now, it's paying the price. I recommend you give your medical record prune juice. If that does not work, try giving it Colace. If that does not work, Miralax.

If it's still holding back, desperate measures may be called for. The next step is an soap suds enema. Giving an enema to a medical record is really unpleasant. They tend to struggle, and, if you are successful, it's really ugly. I would wear an apron and put lots of newspaper on the floor.

Finally, you may have to institute the measure of last resort, the manual disimpaction. This is one of the most unpleasant procedures you can perform, both for you and your medical record. You should definitely wear gloves and hold your breath for as long as possible. However, the result is likely to be cathartic for both you and the medical record.

Once your medical record has become regular, it should be able to update itself just fine.

Of course, if your medical record is already regular, there are other explanations. Some systems, like my dearly beloved Epic, do not automatically discontinue medications that obviously should be discontinued. For instance, the short course of azithromycin (after a buttock injection of ceftriaxone) for gonorrhea should, clearly, automatically stop. If the patient needs it again (and I have had patients like that), the patient should at least come in for a stern talking to about condoms before getting a refill. If your doctor is not rushed and thinks of it, they can write in a discontinuation date for the medication, but the fact that they have to do that for obviously short term medications is ridiculous.

Another possibility is that your medication was discontinued by a doctor who uses a different electronic medical record system. As of right now, there is no automatic way for your pharmacy and your other providers to know when a medication has been discontinued by another doctor. As a primary care provider, theoretically, I get all specialist notes, and I try hard to look through them for important details like discontinuations, but it's time consuming.

It's also very dangerous that pharmacies are not automatically notified when a doctor wants a patient to stop taking a medication. Especially with men and older patients, the patient may not know exactly which pill they are supposed to stop. So, unless the doctor's office calls the pharmacy and tells them not to refill, the patient may continue taking that medication and continue to get that painful genital rash that it causes.

In the end, it often falls to the patient to know which medication to stop taking and to remember to ask your physician to update the EMR manually. You need to keep careful track of your own (and maybe your parents' and grandparents') medications. That's not how it should be. It's highly dangerous, but that's how our messed-up system works. Sorry for the bad news.

Be well,

Dr. Tumoriffic

Getting Your Ducks in a Row

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