A paper cut in a digital world

As I mentally gear up for another week on the inpatient team with our residents, I am vividly remembering a moment from my last week there.

First, a little background.  About five years ago, our hospital went live with an electronic medical record.  True, the documenting system is a bit clunky, but inputting daily progress notes, H&Ps, consults, and discharge summaries electronically became possible.

As a third-year resident here then, I practically leaped for joy.  Gone would be the days of squinting to read Dr. Scribbler's illegible H&P!  Gone would be the days of hunting down a paper chart to read a consult!  I imagined a beautiful new word of efficient legibility.

The majority of the attending staff, as you are probably already imaging, did not share my optimism.  They were unhappy with the clunkiness I alluded to above.  They didn't want to take the time to log in, pull up the right patient, open a new progress note, and type in their thoughts.  "Too many clicks" became their mantra.  The hospital decided to continue allowing paper documentation while the IT folks worked on ways to make physician documentation less cumbersome and more user-friendly.

Fast forward to my time on service last month.  After a lengthy search, I had finally grabbed hold of a patient's paper chart.  As I flipped through the pages to read the surgeon's recommendations for our patient, I felt a familiar sting in my index finger.  A drop of blood welled onto the page I was reading.

Paper cut.  I got a paper cut reading a patient's chart.  Carpal tunnel from clicking the mouse too much?  Ok.  Eye strain from staring at LCD screens for too long?  Understandable.  But a paper cut?!?

It is 2011, and my hospital is still using a hybrid electronic-paper system.  We are far from the only hospital still relying on paper this late into the 21st century.  In all fairness, electronic documentation for physicians does need to become more intuitive and less cumbersome.  But the time has come for us to demand better software, not bury our heads back into the sharp edges of an outmoded paper system.  Resisting better legibility and faster data retrieval denies patients the accurate and timely medical documentation - and care -that they deserve.

Anybody got a band-aid?

Goodbye, old books

My constantly expanding collection of books has been an increasing problem of late.  As an avid reader, I have always worked under the assumption that books are sacred.  Once brought into the home, a book cannot leave.  It is a record of a point in time, forever connected with what was happening when read.

I was an English major in college, and I still have every single one of the novels, anthologies, and poetry collections from that time.  I also ended up with a Chemistry degree, and every time I look at my Physical Chemistry textbook I remember my curve-busting test performance and fill with happy pride.

I am in a wonderful book club with some of my work colleagues, and just about every book we've read in the last seven years is there.

My medical school textbooks similarly still line the bookshelves.  They are all pretty much out-of-date by now, and it's ridiculous to think that I would leaf through the pages of a ten-year-old book to find guidance for my clinical decision making.  Yet I still cling to them; wouldn't it be great to share them with my future residents in thirty years?

("I know, can you imagine - treating type 2 diabetes with insulin and hepatotoxic pills when it turned out to be so obviously curable?  Ha ha ha!")

Lately, though, my husband has kindly confronted me with the reality that our house cannot continue to comfortably accommodate my ever-expanding book collection.  I came to see that, unless we plan to start replacing furniture with bookshelves (who needs a couch, anyway?), the book-to-living-space balance must tip the other direction.  Some of the books needed to go. 

I struggled to accept this fact for quite a while.  These books were like old friends, reminders of times and events, of feelings and ideas.   I slowly came to realize, however, that these reminders of the past were crowding out the here and now.  Worse, I was relying on those books to serve as visual personality props - a way to show off the wealth of my knowledge and experiences.  The final straw was realizing just how many of those books I would never, ever read again. 

So, over the course of a weekend, I sifted through every book on every shelf in the house.  I realized that I didn't need the books to keep the memories or to display the sum of my personality.   When done, I delivered two bags of long neglected tomes to Half-Price Books.  Handing them over was surprisingly easy in the end; I realized that they would all gain new life in the hands of new readers.

Goodbye, old books, and good luck to you all.