Walk into a hospital today and you’ll see nurses huddled over computers instead of standing at the bedside. Why? Electronic records replaced ward clerks and turned nurses and doctors into data-entry staff. #medicine #healthcare #patientsfirst

It’s really an indicator of just how poorly the system is run by current admin and regulators. In no other industry would you have the most menial tasks done by the highest paid & trained workers. Absolute inexcusable misallocation of resources.

YES!!!!!! 100000000%. Nurses hate this. We feel more like chart monkeys that nurses.

it is very easy for physicians to forget that the nurses struggle with the electronic health record as much or more than we do.

And we all double chart similar stuff.

Being forced to interact with a computer screen rather than directly with the patient has robbed us of the greatest gifts we gave to patients. Our direct concern, touch and eye contact. It’s shameful!

Yup. During step down care after heart valve surgery nurses missed that my husband‘s pain pump ran out of pain medicine because they were too busy looking at their carts with the computers on them and the pain pump was not part of what was being monitored. No one touched the patient. it took calling the surgeon and several tests to finally figure out that the pain pump was not working and was empty. All of the nurses were huddled over their carts the whole time. The pain was felt in the stomach and intestinal area. It turned out to be referred pain. the surgeon ordered tests to make sure nothing in that area had gone wrong before realizing it was coming from the empty pain pump. this was about five years ago. My husband got to go back to ICU and one on one care for a few days after that and before he was released and he is doing fine now. I spent a lot of time at the hospital with my husband, and I noticed the nurse focus on their computer monitor carts distinctly and lack of focus on the actual patient and rather on the patients computer readouts, and I remarked on it at the time.

“Back in the 80s nurses were at the bedside” And the 70s, and the 60s, and the 1920s, and the 1880s, and …

Preach. Not just in the hospital. It’s a plague corrupting all patient care everywhere.

THIS. Even working outpatient I feel like all I do is click in the computer. I get evaluated on how fast I can get a patient ready for the docs, can't get histories the way I want to, and the patient basically just stares at me while I update everything. It's sad.

This is because we, doctors and nurses, are nothing more than the User Interface to the computer - the parts that the patients see but the computer is the one calling the shots.

Thank you. Great thoughts and observations

Thank you!

Absolutely! Nowadays the billing mantra is: unless it is documented it did not happen but … just because it is documented does not mean it actually did happen Who is suffering? Our patients!

True. Used to be able to take your nurse's notes and sit anywhere to complete them, including at the bedside. Now nurses can't operate without a computer terminal and AI driven drug dispensing. Even checking vitals is computer driven.

They made my mother retire from nursing. She cites it as the ONLY reason she retired. In her late 70’s, she could still run circles around nurses half her age.

As retired NP/RN I can confirm this.

As a physician, I spend at least 30% of my ER shift on the computer...

Great point. In addition, you’ll see the nursing students doing the same. Clinical skills diminish in that setting.

Yes this is totally true. You are very effective with explaining the troubles in healthcare in a clear and easy to understand manner. Please keep it up!

I enjoy your posts. And there certainly is truth in what you are saying, but the modern EMR is a vast improvement from what we had when I was in training. Labs, imaging reports with the actual images, procedural reports, path reports are available from any computer or smart phone. A large portion of my surgical residency was spent collecting and transcribing data. The good old days weren’t that good

I did an about-face and promptly left the profession because there was no time to care, educate, or advocate properly. For 12 hours, it was a race to tick the tasks and chart, chart, chart.

The first line of this tweet made my brain think you were setting up a joke. Turned out it's reality and nightmare. Wish we could stop and cntrl-alt-del reboot this EHR BS.

The number one burnout driver and missed diagnoses. AI could streamline everything. It's the dumbest system around—designed by bureaucrats, bought by big insurance and big pharma, and manipulated by the Fed to hide/shift the cost of subsidies. FUBAR.

The amount of notes to be entered is very taxing. Nurses have a lot of work with notes. I don't know how they do it.

Physicians are data entry monkeys nowadays….all day long

I've experienced this behavior from docs

I remember your phenomenal and moving presentation! All medical students need to hear it, we must always listen and be humble! People don’t realize it is ok to switch doctors. I hope you and your followers are all doing well!

thank you. All is well. Keep up the great work!

I was a RN in the OR and when electronic records came into play I was too busy recording a dozen timestamps and how many pieces of gauze or towels were used instead of providing direct patient care. It was absurd. They should just replace the nurses with accountants and call it.

Veterinary medicine has become similar. I practice alone and keep paper records in real time mostly because I was tired of the time spent using user unfriendly software when I could be observing my patient. I’m blessed to be able to still choose… for now.

I thought I was to only one to recognize that.

💯 I have always been appalled that nurses were caring for computers rather than the patients. In the 80s, care plans were done by hand and nurses still struggled with them. Maybe bring back nurse assistants and attendants - that’s where I started.

EXACTLY!!! Poorly designed EHRs fueled by unnecessary rules/regs, mandated and mostly useless documentation requirements have taken us away from what is most important-> patients and patient care. Takes our eye off the ball. Would be akin to having Steph Curry keep his own stats during, and while playing a game. How effective would he be???

And it is not even cost effective. When our hospital switched to EMR hospitalist cap went from 20 to 15 patients a day. 5 fewer patients a day getting cared for multiply by 6 teams that is 30 patients less a day in the hospital or hire 2 more doctors.

Dear @HHSGov and @RobertKennedyJr

Nurses shouldn’t spend more time typing than caring for patients.

The computer should be the tool. But the system made tools of doctors and nurses.

Fact.

Its actually worse. Recently my doctors ask my permission to record our session sobtgat their AI app can transcribe it as medical notes for my chart. They don’t even have to think and anakyze and write a diagnosis any more. Frankly Grok does better than they do and I now feed Grok all lab results before my actual appt so that I can “dictate” appropriate questions in my recorded session. Thats crazy, right?

As a patient EMR are invasive and prevent quality health care. One can't get a true second opinion because the diagnoses is already in the EMR. And why does my ophthalmologist need to read notes on my obgyn visit? 🙄