Home Forums Discussions Problems DEEP THOUGHHTS by Walter Handy

Wendell, I again want to defend those of us who cannot walk and chew gum at the same time against the relentless onslaught of templates.

For me, trying to do the in depth part of the chart in the room is distracting; I want to be paying attention of the nuances of what the patient is saying, ask questions at just the right moment, etc. I would never, never trust a third party to do what I consider the most critical task in internal medicine; getting a coherent chief complaint is problematic enough. I use the computer to take brief notes for the HPI. With an established patient, the PH, FH, SH are all there.. otherwise, again with brief notes. The ROS starts with a negative template, gets modified. The physical exam is left blank. Prescriptions and orders autofill as I go.

I conclude with the patient. My schedule is such that I always have 5-10 minute breaks. I put the laptop in its cradle, switch on Dragon, dictate the HPI using no template other than the introduction with the %MR %LNAME placeholders. Template the physical exam, modify it. click on the plan, dictate not only what I did, but even more importantly why I did it, what I was thinking, and where I am going. All of that takes much less than 5 minutes, most of which was gleaned by NOT spending time mumbling over the computer in the room and dealing with which of 100 templates I want to use. My full attention is on each task. The patient knows he/she is being listened to. I am done before the next patient is ready to be seen. I am out the door 5 minutes after the last patient of the day.

Clearly, templates are a godsend for many. But, not all. All 4 of us in this office have adapted to doing pretty much as I described. All of us go home on time. Our notes make it clear that care was given by a physician, not a MA with a keyboard. I only need to log in from home on weekends to check labs and UpDox.

Square pegs don't go into round holes very well. But, a properly sized square peg fits very nicely into the properly sized square hole, and the end result is just as nice.