Physicians/Healthcare Professionals -EMR Question

[Professor Nono]

I don't want electronic medical records. Are there physicians out there that will just take cash money for a visit and just use the old fashioned written chart anymore? Not that I have something that won't come off even with a brillo pad - it's a privacy thang with me. If there is such a physician, who are they? Knoxville Area.

 

[tumscalcium]

I don't want electronic medical records. Are there physicians out there that will just take cash money for a visit and just use the old fashioned written chart anymore? Not that I have something that won't come off even with a brillo pad - it's a privacy thang with me. If there is such a physician, who are they? Knoxville Area.

+1

 

[g8terh8ter_eric]

I don't want electronic medical records. Are there physicians out there that will just take cash money for a visit and just use the old fashioned written chart anymore? Not that I have something that won't come off even with a brillo pad - it's a privacy thang with me. If there is such a physician, who are they? Knoxville Area.

Not going to happen. Any doctor worth their weight is using EMR right now, and the fact that if they are not they won't be compensated by Medicare, will close the doors by anyone who refuses. In fact, the people who use paper, are less secure than those using EMR. There are multiple security protocols with EMR, and really zero with paper. So, pretty much anyone with eyes can read your paper chart, not so much with EMR.

Good luck with your herpegonosyphilaids. :hi:

 

[Professor Nono]

Don't want a doctor "worth his weight." I want somebody to write me a scrip when I tell them what is wrong. Surely not all docs take medicare. Pediatricians?

EMR is secure? By the way, I don't give the first dam@ if a private citizen sees my records - big deal. But, if a bureaucrat somewhere wants to peruse my records to see if I'm still fit to drive, be a parent, own a gun, vote......well, I'm not really down with that.

 

[kiddiedoc]

Don't want a doctor "worth his weight." I want somebody to write me a scrip when I tell them what is wrong. Surely not all docs take medicare. Pediatricians?

Doesn't sound like you need a doctor if you already know what's wrong. Maybe you should apply for your license and sit for the medical board of your choosing.

I'm a Pediatrician, and I see about 40% Medicaid. The area where I practice is largely indigent and I made the decision to care for the children, no matter their circumstance. We do use an EMR, but did so a bit begrudgingly due to government incentives/penalties.

All this being said, I completely sympathize with your questions regarding the confidentiality of an electronic record. Most docs feel the same, but we were strong-armed. It only seems rational to believe that government, insurance companies, employers, etc will push to use them for information in the future. They are already required to be compatible with a uniform coding system that would allow, at the least, diagnostic codes, medications, etc to be transferable. Also, there have already been cases of hacking.

 

[joevol33]

Kind of related, but we had bcbs at work until the start of last year. A month ago we all got a note from work stating all of our records had been hacked jeopardizing all of our personal data, including ss numbers. Not blaming a Dr in anyway, or the insurance. Its just scary that someone has all this info about my family. Their health, ss #, etc.

 

[kiddiedoc]

Kind of related, but we had bcbs at work until the start of last year. A month ago we all got a note from work stating all of our records had been hacked jeopardizing all of our personal data, including ss numbers. Not blaming a Dr in anyway, or the insurance. Its just scary that someone has all this info about my family. Their health, ss #, etc.

Like I said, my friend, we are on the same side. Uncle Sam has enjoyed making docs look like the bad guys, but we are all in the same boat.

 

[g8terh8ter_eric]

delete

 

[Professor Nono]

Doesn't sound like you need a doctor if you already know what's wrong. Maybe you should apply for your license and sit for the medical board of your choosing.

I'm a Pediatrician, and I see about 40% Medicaid. The area where I practice is largely indigent and I made the decision to care for the children, no matter their circumstance. We do use an EMR, but did so a bit begrudgingly due to government incentives/penalties.

All this being said, I completely sympathize with your questions regarding the confidentiality of an electronic record. Most docs feel the same, but we were strong-armed. It only seems rational to believe that government, insurance companies, employers, etc will push to use them for information in the future. They are already required to be compatible with a uniform coding system that would allow, at the least, diagnostic codes, medications, etc to be transferable. Also, there have already been cases of hacking.

I get it - for just regular stuff, I don't need a high end guy nor do I have to put it on my insurance. But for the stuff that is worse - ie - appendix or whatever - it would need to go on insurance. But I can tell you that I will walk in, point to what is wrong, and grunt something like "fix this." then shut up.

We know that the docs aren't the bad guys here. But it is all about control.

 

[McDad]

Doesn't sound like you need a doctor if you already know what's wrong. Maybe you should apply for your license and sit for the medical board of your choosing.

I frequently agree with you and I continue that trend in response to the whole of your post.

However and please understand this isn't directed at you but more of a comment about Drs due to the portion I quoted.

Why do doctors feel it necessary to say what you said in your post? Are people really in need of being reminded that you have an advanced degree, a license to treat, knowledge about the body, information on diseases that the layman cannot replicate?

If you feel it is dangerous, harmful, or even potentially fatal to self dx then why not say that and lose the snarky tone? I promise the hubris does nothing to convince a pt they need an actual licensed dr rather than an online resource or Uncle Jim who works as a vet tech.

End rant.

 

[kiddiedoc]

Sorry if that came across a little rough, but I deal with absolute crap care from retail walk-in clinics and small-time ERs all the time, not to mention people who just walk in and tell you what they think they need.

Yes, you're right: self-diagnosis can be very dangerous, and it's hard to be objective about your own health. I try to serve my patients and profession with dignity by not being a short-order cook. It's amazing how often a symptom or constellation of them ends up having a surprise cause, and it is very frustrating when poorly trained or inexperienced providers give inappropriate treatments or diagnoses for what should be common ailments.

Point is: it is very important to have a physician you can trust to hear your complaints, examine you thoroughly, and treat you based on current evidence-based medicine. That's not unique to medical care, but any professional service. You don't seek legal counsel and tell them how to handle a case or courtroom, you don't hire a financial advisor so you can tell them what to invest in, etc.

I guess I took it a little personally that the OP said he wanted to be able to tell someone what he needed and get it. That's on me, sorry.

 

[joevol33]

So do does self diagnosed genius status not count kiddiedoc????? Ha, doesn't with my wife anyway.

 

[kiddiedoc]

Why do doctors feel it necessary to say what you said in your post? Are people really in need of being reminded that you have an advanced degree, a license to treat, knowledge about the body, information on diseases that the layman cannot replicate?

One more thing, and this is important: I think in this era, people do need that reminder. With rising healthcare costs and crazy high deductible plans, a lot of people are bargain shopping. You can go to Walgreen's and see an NP with no local supervising MD for less $ than seeing a primary care doc in the office. But, the care is not the same. And, you sure as heck have no business treating yourself with no formal education or training.

I wouldn't dare go out and start opening up my car engine or rewire my house with my current knowledge of either field. Your body is infinitely more complex and undeniably more valuable.

 

[kiddiedoc]

So do does self diagnosed genius status not count kiddiedoc????? Ha, doesn't with my wife anyway.

Of course it does. You'll be fine

 

[McDad]

Sorry if that came across a little rough, but I deal with absolute crap care from retail walk-in clinics and small-time ERs all the time, not to mention people who just walk in and tell you what they think they need.

Yes, you're right: self-diagnosis can be very dangerous, and it's hard to be objective about your own health. I try to serve my patients and profession with dignity by not being a short-order cook. It's amazing how often a symptom or constellation of them ends up having a surprise cause, and it is very frustrating when poorly trained or inexperienced providers give inappropriate treatments or diagnoses for what should be common ailments.

Point is: it is very important to have a physician you can trust to hear your complaints, examine you thoroughly, and treat you based on current evidence-based medicine. That's not unique to medical care, but any professional service. You don't seek legal counsel and tell them how to handle a case or courtroom, you don't hire a financial advisor so you can tell them what to invest in, etc.

I guess I took it a little personally that the OP said he wanted to be able to tell someone what he needed and get it. That's on me, sorry.

I understand. And I appreciate the vital role you serve in helping pts. Thanks for understanding my gripe.

On a lighter note, it's easier treating laymen who self diagnose than it is trwating other doctors and/or their family.

 

[McDad]

One more thing, and this is important: I think in this era, people do need that reminder. With rising healthcare costs and crazy high deductible plans, a lot of people are bargain shopping. You can go to Walgreen's and see an NP with no local supervising MD for less $ than seeing a primary care doc in the office. But, the care is not the same. And, you sure as heck have no business treating yourself with no formal education or training.

I wouldn't dare go out and start opening up my car engine or rewire my house with my current knowledge of either field. Your body is infinitely more complex and undeniably more valuable.

Agreed. But it isn't the patient's fault that the nursing board pursued and gained portal of entry privileges for NPs.

 

[Professor Nono]

Guys - would you agree with me that some patients are capable of self diagnosing whereas others are not? One rule for all is called protocol. I prefer discretion.

And I'm not talking about a stomach pain with blood in the stool self-diagnosis. I'm talking about green snot diagnosis.

 

[kiddiedoc]

I'm talking about green snot diagnosis.

A recent study showed that 96% of "bacterial sinusitis" diagnoses were inaccurate. Green snot = it's been in there a while. Usually viral, irritant, or allergic rhinitis. Other possibilities are nonallergic chronic rhinitis and (esp in kids) foreign bodies. Ex: I saw a 2 or 3 year old a couple of years ago with thick nasty green snot for 3-4 weeks. On exam, barely saw some weird-looking green-lined debris deep in the nasal cavity. Alligator forceps and I pulled out a rolled up dollar bill dripping with some of the foulest crap you've ever seen.

So, no.

 

[kiddiedoc]

Agreed. But it isn't the patient's fault that the nursing board pursued and gained portal of entry privileges for NPs.

True that. But don't think retail clinics didn't have their spoon in the stew.

 

[Professor Nono]

A recent study showed that 96% of "bacterial sinusitis" diagnoses were inaccurate. Green snot = it's been in there a while. Usually viral, irritant, or allergic rhinitis. Other possibilities are nonallergic chronic rhinitis and (esp in kids) foreign bodies. Ex: I saw a 2 or 3 year old a couple of years ago with thick nasty green snot for 3-4 weeks. On exam, barely saw some weird-looking green-lined debris deep in the nasal cavity. Alligator forceps and I pulled out a rolled up dollar bill dripping with some of the foulest crap you've ever seen.

So, no.

You certainly are not assuming that the threshold for patient diagnosis decision-making should be that made by a child who shoved a dollar bill up his/her nose? Interesting - I hope you took photographs for posterity.

I understand about the problems with self-diagnosing. Some people are just too damned stupid. But I think that other people are smart enough to self-diagnose - KNOWING the risk that they are taking by not consulting a physician.

Certainly there is no substitute for experience.
But how much experience does it take to self-diagnose recurrent tinea versicolor, a wart, or maybe poison ivy rash after clearing land? Not much. Gimme a steroid shot and I'm outa here.

But this idea cuts at your profession two ways: first, it stands for the proposition that the repeat patient might not need to be physically examined (which cuts into your wallet) and second, it stands for the proposition that your profession is not needed for at least a portion of the medical conditions out there (which hits your wallet). I wouldn't like it either if I were a physician.

To get back on point though, I'm looking for a physician who takes cash and writes down the diagnosis on paper. I just don't want anybody up in my business. I go to a mechanic - fix my alternator. Here's $100 and no, you don't need my name, address, telephone number, ss # and DOB. Here's the $100, fix the car.

Same with docs. Here's a $100. Fix my toe. No, you don't need my name, address, phone number, ss#, DOB etc... Fix my toe. Here's $100.

 

[Velo Vol]

And, you sure as heck have no business treating yourself with no formal education or training.

That's what the Internet is for.

 

[Velo Vol]

To get back on point though, I'm looking for a physician who takes cash and writes down the diagnosis on paper.

Putting aside the whole sharing of medical information issue, how many businesses today keep all of their records on paper? It's 2015.

 

[Professor Nono]

Putting aside the whole sharing of medical information issue, how many businesses today keep all of their records on paper? It's 2015.

To answer your question, 4. Where are they? That's the question I am trying to get answered.

 

[xJesusx56]

A recent study showed that 96% of "bacterial sinusitis" diagnoses were inaccurate. Green snot = it's been in there a while. Usually viral, irritant, or allergic rhinitis. Other possibilities are nonallergic chronic rhinitis and (esp in kids) foreign bodies. Ex: I saw a 2 or 3 year old a couple of years ago with thick nasty green snot for 3-4 weeks. On exam, barely saw some weird-looking green-lined debris deep in the nasal cavity. Alligator forceps and I pulled out a rolled up dollar bill dripping with some of the foulest crap you've ever seen.

So, no.

That was his version of a piggy bank. You robbed the poor kid of his life savings.

 

[kiddiedoc]

You certainly are not assuming that the threshold for patient diagnosis decision-making should be that made by a child who shoved a dollar bill up his/her nose? Interesting - I hope you took photographs for posterity.

****

To get back on point though, I'm looking for a physician who takes cash and writes down the diagnosis on paper. I just don't want anybody up in my business. I go to a mechanic - fix my alternator. Here's $100 and no, you don't need my name, address, telephone number, ss # and DOB. Here's the $100, fix the car.

Same with docs. Here's a $100. Fix my toe. No, you don't need my name, address, phone number, ss#, DOB etc... Fix my toe. Here's $100.

Thanks for the smart-assed response, but I actually explained that green snot is usually viral infection, allergies, or irritant.

Good luck finding someone with your requirements. Given the current medico-legal landscape and need for contact info for telephone follow-up (which we routinely provide without charge), you might check in the back of some trailers along the interstate in Florida. I hear you can't get cheap CT scans there, too. Medications are not well-regulated in Mexico, so there is another option, and you wouldn't even need a physician.