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I see them.  They are sitting right next to me right now.  While I type this there is a certain amount of guilt that their presence radiates towards me.  They never say anything, but they don’t have to.  They just sit there smugly knowing that they live somewhere in the recesses of my brain waiting to spin their net of shame on me whenever they catch my eye.

I hate looking through old records.  As I write this (and every blog post, really), I am procrastinating a task that I equate to cleaning the attic.  It’s something you know you probably ought to do, but do you really need to do it?  Nobody will know if you don’t.

Those non-medical types won’t understand my emotions, but I suspect I am not alone in the medical community.  Slogging through a pile of information that is 98% useless and taking up lots of time in the process is not something to be eagerly anticipated.  Who cares what someone’s mammogram 8 years ago showed when they have had them annually since then?  Who cares what the child’s height was when they were 9 months of age when they are now 13 years old?  Who cares about a sinus infection in 1996?

Besides, most doctors do a lousy job keeping their records and have illegible handwriting.

There are four reasons medical records are kept:

1. So the healthcare provider gets paid.  We are paid based on our charting, and the rules that govern the process (which I have documented in the past) make it such that most of the notes are just filler to satisfy the regulations.
2. “For future reference.”  – Who knows what information what you need in the future?  It’s a good thing to keep stuff so that if you need it, you will be able to access what you need.
3. Because if we don’t the information would be gone forever.  We are the only ones keeping records of certain things, and so if those records are lost, those visits are lost forever.
4. So we can torture the conscience of any doctor after us that takes care of the patient.

But isn’t there useful information in medical records?  Of course, but not as much as you would think.

At home, I hold on to bills I have paid for three years.  I do this because somebody somewhere said I should.  The argument is that they may be needed in the future, so you hang on to them “just in case.”  I certainly understand having bills over the past month, and even the past six months; but why do I need the water bill from March of 2006?  The same thing is true with medical records.  You rarely use the information that is over a year old.  There are some pieces of information, like immunization records and colonoscopy reports that are necessary to know, but in general a summary of them should be fine.

Furthermore, the labs and hospitals have all of the lab and radiology reports for the patient, so I don’t really need the actual report, just the summary in a flow sheet (like a bank statement for the bills you paid).

One of the real benefits of a national health information network is that information won’t have to be duplicated as much.  I don’t need to keep old records on patients, I just need access to their information.  So if I need a mammogram report, I just go online to the radiology database and look it up.  If I need to know their last few cholesterols, I get those from the lab results database.  If I want their medication history, I log on to the e-prescribing network that keeps those records far more accurately than doctors do.

I know, I know, “What about security?”  I don’t think there should be a central database.  I wouldn’t want that for my money and I really don’t want that for healthcare records.  I would just want access to what I need and have authorization to access; kind of like having access to bank accounts online and allowing one bank to electronically withdraw money from another.

But that’s another discussion.

Now I just sit here with the leering presence of a stack of mostly useless information.  The taunt me.

Sometimes I dream at night that I am being chased around by stacks of illegible notes, screaming at me and telling me what a horrible person I am.  Other times I dream I am on a witness stand testifying and in walks a pile of old records that walks before the judge, points at me, and screams “He’s the one!  He’s the one who never looked at me!  Throw him out to where there is weeping and gnashing of teeth!”  Then the courtroom is in an uproar, cameras flash, ladies weep and children scream.

Then I wake up and decide it is time to clean the attic.

Tagged as: Being a Doctor, Old Records