{"id":2076,"date":"2016-12-28T13:17:35","date_gmt":"2016-12-28T18:17:35","guid":{"rendered":"http:\/\/blogs.nejm.org\/general-medicine\/?p=2076"},"modified":"2016-12-28T13:17:35","modified_gmt":"2016-12-28T18:17:35","slug":"reflection-hippocratic-oath","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2016\/12\/reflection-hippocratic-oath\/","title":{"rendered":"A Reflection on The Hippocratic Oath"},"content":{"rendered":"
\"Kashif<\/a>

Kashif Shaikh, MD, is the 2016-17 Chief Resident in Internal Medicine at the University of Central Florida College of Medicine.<\/p><\/div>\n

Questions for young physicians:<\/h4>\n

Do you remember and recall the series of events that inspired you to become a healthcare provider? Are you satisfied with the field of medicine? Have you ever thought\u00a0about your perceptions of healthcare before and after becoming a physician? Have you ever been a patient yourself?\u00a0What attributes in our healthcare system do\u00a0you wish didn\u2019t exist or need\u00a0to change?<\/p>\n

After finishing my rounds in the ICU, I was speaking to one of our charge nurses. We were discussing the advent of electronic health records and charting and its effects on patient satisfaction. She has been a nurse at our hospital for more than 25 years.\u00a0Her thoughts: She was able to chart effectively and efficiently before the advent of EMRs,\u00a0and she\u00a0was also able to spend considerable amount of time at the bedside speaking with patients. But now, she must meet the excessive demands of EMR charting, which are strictly enforced. This has\u00a0led to a decreased amount of time spent at the bedside with patients.<\/p>\n

Patient satisfaction scores and charting are\u00a0key determinants in hospital reimbursement these days. Insurance companies are\u00a0the main driver in the relationship between adequate charting and hospital reimbursement.\u00a0But the required\u00a0“adequate\u00a0charting”\u00a0affects patient satisfaction scores in inadvertent ways:\u00a0A frequent complaint that we hear from our patients is that the providers don\u2019t spend enough time talking to them at the bedside!<\/p>\n

<\/a>

Papyrus text: fragment of Hippocratic oath. Wellcome Library, London. Wellcome Images (http:\/\/wellcomeimages.org). Copyrighted work available under Creative Commons Attribution only license CC BY 4.0.<\/p><\/div>\n

Here is he modern Hippocratic oath,\u00a0to refresh our memories:<\/p>\n

\u201cI will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person\u2019s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.\u201d<\/em><\/strong><\/p>\n

I had another conversation, similar to the one I had with our nurse,\u00a0with one of our senior vascular surgeons. He has been a surgeon for more than 30 years. He mentioned how he spends hours working on his daily progress notes on the electronic health record. We also discuss\u00a0how much time is\u00a0spent on charting in the U.S.\u00a0compared\u00a0with other countries. For example, in the U.K.,\u00a0charting is done specifically to document pertinent patient information, for the sole purpose of patient care, rather than to justify requirements of insurance companies for billing purposes.<\/p>\n

Sadly, today, most providers at the hospital are busy charting and documenting patient care in front of computer screens. Providers go to great lengths\u00a0to meet requirements for healthcare reimbursement, and most of them are under time constraints to complete their paperwork. They also\u00a0put in orders\u00a0 electronically.\u00a0These tasks\u00a0directly affects the amount of time spent at the bedside talking to the patients. The components in the history & physical and progress notes mandated by the insurance companies require a substantial effort, and some of those requirements have no bearing\u00a0on patient care.<\/p>\n

\"By<\/a>

By Jerry Berger [CC BY-SA 4.0], via Wikimedia Commons<\/p><\/div>I agree that EMRs\u00a0are a\u00a0more cost-effective and efficient way to track patient care than is paper charting. It is also an effective way to put in\u00a0orders. But a universal EMR would save tremendous resources. But we need to define an effective universal\u00a0EMR system\u00a0for documentation and charting that\u00a0targets patient safety, quality, and continuity of care.\u00a0Those functions\u00a0would\u00a0allow us to do what healthcare providers need to do:\u00a0Spend time at the bedside talking to our patients and their families (read: increase patient satisfaction). It would also foster\u00a0good rapport between healthcare teams and patients.<\/p>\n

\"Foto<\/a>

Foto de la Biblioteca Vaticana scan from book. User: Rmrfstar [Public domain], via Wikimedia Commons<\/p><\/div>\n

\"Clinic<\/a>

Clinic Painter [CC BY 3.0], via Wikimedia Commons<\/p><\/div>I hope as the time goes by, we see some positive changes in more effective utilization of EMR. Should we allow insurance companies and legislation to define healthcare practice?<\/p>\n

I would like to end this article on the last paragraph of the Hippocratic Oath.<\/p>\n

\u201cIf I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.\u201d<\/em><\/strong><\/p>\n

 <\/p>\n

\"NEJM<\/a><\/p>\n

Residency isn\u2019t easy. But it doesn\u2019t have to be quite <\/em>so hard. Explore NEJM Resident 360.<\/a><\/p>\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"

Questions for young physicians: Do you remember and recall the series of events that inspired you to become a healthcare provider? Are you satisfied with the field of medicine? Have you ever thought\u00a0about your perceptions of healthcare before and after becoming a physician? 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