The Red Tape Empire
We are, as a nation, in love with bureaucracy. If you stop to think about it the majority of workers, from the limpid drones toiling in sunless cubicles to the smug, upper level managers are involved either wholly or in part in entering data, collating it, wrestling with it, and producing some kind of report on it to be devoured by other bureaucrats. Most of it is useless and of no practical significance to anything real that walks in the light of day but it is essential raw material for the Red Tape Empire, the complicated web of mistrust that now passes for civilization.
In the Good Old Days, back when bureaucracy was limited to the speed of a typist there was a natural check on the proliferation of this sort of thing. Now, in a completely computerized age there seems to be no limit to the amount of paperwork that can be generated to describe the simplest action of life.
I bought a donut and coffee today and was handed three separate pieces of paper to record the transaction.
I am an Emergency Physician and work in deep in the heart of the Red Tape Empire. My job is mostly data entry and while I occasionally treat a patient or save somebody's life, this is only a very small, unimportant part of my responsibilities. It would not be an exaggeration to say that three-quarters of my time is spent in front of a screen maneuvering through some abortion of an Electronic Medical Record system or filling out forms of one flavor or another.
If the public really knew how much of their physician's and nurse's time is spent entering data and wrestling with the ever expanding documentation requirement of the bureaucratic state they would probably revolt...except of course that I have noticed a distressing trend to accept senseless paperwork as a necessary part of normal living.
If you go to hospital and don't have to fill out and sign twenty pages of disclosure, disclaimers, and warnings you feel like you are being cheated.
Paperwork, much of it but not all done on the ubiquitous hospital computers, is so pervasive in medicine and so distracting from our mission that it significantly decreases our ability to examine, contemplate, and wisely treat our patients. There simply isn't enough time to take care of patients and perform our primary job as data entry clerks.
Data is killing us. Entering it, organizing it, and verifying it sucks the life out of medicine. Patient care is sacrificed to it and there is no end in sight. It is an unstated but nevertheless practical truth that this documentation and data entry is more important to the all-engulfing bureaucracy than patient care. You can be the best doctor in the world, practically raise the dead, but if your paperwork isn't done exactly to specification you will run afoul of the bureaucracy. Conversely, you can be Jack Kevorkian but as long as you fill out all the forms you are golden.
The purpose of this documentation is three-fold and in every case a result of a lack or basic trust in medical and nursing professionals to do their jobs without oppressive supervision. Firstly, the government and the insurance companies that mirror their policies use paperwork as a tool to deny payment for services. As the saying goes, if it wasn't documented, it wasn't done so complicated rules have been implemented to ensure that the so-called "level of service" for a patient visit can be downgraded as much as possible resulting in less payments to physicians.
To counter this, and secondly, private physicians and hospitals adopt complicated and unwieldy Electronic Medical Record systems that seek to ensure that everything that needs to be documented is documented (whether it was actually done or not which is another topic) to ensure that they are paid fairly for their work. This has lead to a documentation arms race as keystroke-driven boilerplate generators add more and more useless information to the medical record...to the point that if you come to my ER for a simple sore throat you will automatically generate a fifteen page chart full or useless information even before I add my data to the pile.
Finally, documentation is seen as a protection from the predatory plaintiff's attorney's whose depredations add so much to the cost of your medical care. In my line of work it is usually the hospitals way of assigning blame to doctors and nurses by forensic examination of stacks of documentation.
We are, as a nation, in love with bureaucracy. If you stop to think about it the majority of workers, from the limpid drones toiling in sunless cubicles to the smug, upper level managers are involved either wholly or in part in entering data, collating it, wrestling with it, and producing some kind of report on it to be devoured by other bureaucrats. Most of it is useless and of no practical significance to anything real that walks in the light of day but it is essential raw material for the Red Tape Empire, the complicated web of mistrust that now passes for civilization.
In the Good Old Days, back when bureaucracy was limited to the speed of a typist there was a natural check on the proliferation of this sort of thing. Now, in a completely computerized age there seems to be no limit to the amount of paperwork that can be generated to describe the simplest action of life.
I bought a donut and coffee today and was handed three separate pieces of paper to record the transaction.
I am an Emergency Physician and work in deep in the heart of the Red Tape Empire. My job is mostly data entry and while I occasionally treat a patient or save somebody's life, this is only a very small, unimportant part of my responsibilities. It would not be an exaggeration to say that three-quarters of my time is spent in front of a screen maneuvering through some abortion of an Electronic Medical Record system or filling out forms of one flavor or another.
If the public really knew how much of their physician's and nurse's time is spent entering data and wrestling with the ever expanding documentation requirement of the bureaucratic state they would probably revolt...except of course that I have noticed a distressing trend to accept senseless paperwork as a necessary part of normal living.
If you go to hospital and don't have to fill out and sign twenty pages of disclosure, disclaimers, and warnings you feel like you are being cheated.
Paperwork, much of it but not all done on the ubiquitous hospital computers, is so pervasive in medicine and so distracting from our mission that it significantly decreases our ability to examine, contemplate, and wisely treat our patients. There simply isn't enough time to take care of patients and perform our primary job as data entry clerks.
Data is killing us. Entering it, organizing it, and verifying it sucks the life out of medicine. Patient care is sacrificed to it and there is no end in sight. It is an unstated but nevertheless practical truth that this documentation and data entry is more important to the all-engulfing bureaucracy than patient care. You can be the best doctor in the world, practically raise the dead, but if your paperwork isn't done exactly to specification you will run afoul of the bureaucracy. Conversely, you can be Jack Kevorkian but as long as you fill out all the forms you are golden.
The purpose of this documentation is three-fold and in every case a result of a lack or basic trust in medical and nursing professionals to do their jobs without oppressive supervision. Firstly, the government and the insurance companies that mirror their policies use paperwork as a tool to deny payment for services. As the saying goes, if it wasn't documented, it wasn't done so complicated rules have been implemented to ensure that the so-called "level of service" for a patient visit can be downgraded as much as possible resulting in less payments to physicians.
To counter this, and secondly, private physicians and hospitals adopt complicated and unwieldy Electronic Medical Record systems that seek to ensure that everything that needs to be documented is documented (whether it was actually done or not which is another topic) to ensure that they are paid fairly for their work. This has lead to a documentation arms race as keystroke-driven boilerplate generators add more and more useless information to the medical record...to the point that if you come to my ER for a simple sore throat you will automatically generate a fifteen page chart full or useless information even before I add my data to the pile.
Finally, documentation is seen as a protection from the predatory plaintiff's attorney's whose depredations add so much to the cost of your medical care. In my line of work it is usually the hospitals way of assigning blame to doctors and nurses by forensic examination of stacks of documentation.
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