Letters: Readers comment on Medical Economics stories

The danger of EHRs

"Using manual, paper-based processes that are more akin to Eisenhower's era than today's modern world, healthcare is the largest and most antiquated part of our economy," former U.S. Speaker of the House Newt Gingrich has stated in support of electronic health records. "[There is] irrefutable evidence and experience that information technology saves lives and saves money."

Not so! A July 2008 article in the Archives of Internal Medicine found that on 14 of 17 patient-visit quality indicators, there was no significant difference in performance between practices that used an EHR and those that did not.

Howard Long, MD, MPH
Pleasanton, California

Editor's note: To learn more about EHR systems' problems with coding compliance, turn to "Many EHRs create coding errors".

When you are the patient

I empathize with Dr. Richard Waltman, who recently shared his reflections on the experience of being a patient ["In sickness and in healthcare," From the Board, February 20, 2009].

As an internist, I admit that a few years back I didn't know much about autism with regard to workup and treatment options. I remember how anxious my husband and I felt as we drove to attend our appointment with the developmental neurologist.

I was pregnant in my first trimester, and my son was a few months past his second birthday. We had noticed delays in his speech and changes in his behavior, being more isolated and not making eye contact.

After meeting the team involved in the assessment of my son, we waited impatiently for the result. The physician, who I still think is excellent in his field, came in and informed us that what we were suspecting is true: My son has autism. I remember bursting into tears, hearing scattered words among many sentences about tests to be done and options of therapy. I had to step out, as I felt dizzy, and I remember the nurse following me to see if I would need any help.

Later we went back home, still in shock. I had expected the diagnosis, but deep inside I was hoping to be wrong. That evening, I started having cramps, and in a week I lost the baby. Breaking bad news is an important communication skill, taking many factors into consideration. I remember, in my first year of residency, watching a video about techniques used to facilitate breaking bad news to patients. It was our program director's idea to teach residents a task considered one of physicians' most difficult duties.

My lessons from that experience are to leave enough time for silence, and that it's probably appropriate to go over treatment options in another visit unless something is needed urgently. It's also best not to assume that physician-patients would react differently than non-physicians or would have sufficient knowledge of the condition.

Mayada Issa, MD
Morgantown, West Virginia