The only voice she hears

2007-02-16 - 1:23 p.m.

In the hospital where I work, a great deal of the charting and what not is done on computers. We're nearing paperlessness, although we're not quite there yet. This is good because typing (for most people) is faster than writing, because typing is always legible whereas handwriting often is not, and because progress notes can simply be cut and pasted from one day to the next with modification made where necessary instead of starting from scratch. This cutting and pasting is becoming more and more common. It's a little boring to see nearly the same exact note on the more stable patients every day, but I don't really have a problem with it. What I do have a problem with is the way residents (and attendings too) will cut and paste a note without reading it. The same obvious errors are perpetuated day after day. I can correct something one day, but unless I nag the resident to get it right in the note, it'll be wrong the next day too. And less dangerous errors like spelling mistakes and lack of flow are repeated endlessly. For example, the following is taken directly from a patient's chart, in the "plan" section. This is the part where they summarize everything, listing each of the patient's problems discreetly along with the plan for how they will deal with it:

LEUKOCYTOSIS: PMN predominance, no left shift. Would be late for demarginalization 2/2 to steroids since now on steroid taper. ddx: new infection (aspiration event, ascending UTI, cdiff) but afebrile.
- pan culture
- consider antipseudomal coverage for empiric antibiotic therapy given hospitalization >5 days

COPD EXACERBATION, likely PNA as well.
- stable at low-dose oxygen.
-bipap trial tonight as per Dr. X, otherwise increase O2 to 3L overnight.
- ABx completed - 5d of azithromycin; 3d of clindamycin.
- continue duonebs qid, alb prn.
- tapering off steroid
- Will likely need to be discharged home to recooperate before any urologic procedure.
- consult to rehab for eval.

HISTORY OF CORONARY ARTERY DISEASE.
- no medication at this point - holding atenolol 2/2 COPD, restart home dose on d/c
- need to address Tx

This has been bugging me all week. The underlined point (underlining done by the doctor). It may be true, but it certainly has nothing to do with COPD and I'm fairly sure the patient is being sent home to recuperate, not to cooperate again. I know, I can be anal about some things, but I would be mortified to have my name attached to a progress note that looks like this and the fact that one resident has been submitting this same note every day for a week fairly well proves to me that he hasn't actually been reading it. How could any doctor sign his name to something in an official medical chart that he hasn't even read? What else hasn't he read? What else hasn't he noticed? It's scary. It's so easy just to hit the "OK" button without reading what you're agreeing to.

Did I mention I'm reading a really good book? It's The Scar by China Miéville. The writing is absolutely amazing. I read his book Perdido Street Station before and loved it too. The thing is that his writing is really dark and incredibly dirty. He uses the F word regularly. And yet, it's beautiful. Absolutely amazing writing, I'm telling you. He regularly uses words I don't know (and I think I have a fairly large vocabulary) but he doesn't sound like he's trying too hard. It all flows so easily. Smooth. And gripping! I have 50 pages left and it's killing me that I can't be reading it right now (I'm at work). I'm dying to know what's going to happen next. Not only that, but the writing is just so good that I'm dying to read some more of it--who cares what happens next, I just need another hit of China Miéville.