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Less Is More
June 2015

When Documentation Supersedes Patient Communication: An Example From an Endoscopy Unit

Author Affiliations
  • 1University of Texas Southwestern Medical Center, Dallas
  • 2BayCare Health System, Clearwater, Florida
JAMA Intern Med. 2015;175(6):884-885. doi:10.1001/jamainternmed.2015.1100

A patient who underwent screening colonoscopy at our hospital made an astute observation: many of the questions that he was asked in a preprocedure assessment seemed out of place and irrelevant. Among the questions were, “Do you want to know more about your health condition?” and “Are you interested in ways to keep you healthy?” The patient asked us what we did with his answers. The truth was that the answers did not alter his care in any way. Agreeing with the patient’s sentiments, we investigated the rationale behind the questions in the preprocedure learning assessment (Table).

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    2 Comments for this article
    David Kwiat, MD | Kaiser Permanente
    This article documents what many of us have discussed in conversations with our colleagues and co-workers. So much of our documentation and other communications are meaningless and serves only to satisfy some regulatory agency or an attempt to fend off legal problems. Maybe it’s time we get back to doing what’s best for the patients and not the medical system…
    More true
    Mark Mc Connell | Private Practice
    Even more true 7 years after publication.
    Those who promote the benefits of EMRs may not also measure the downsides. Yes, it is nice to be able to retrieve past information (however, with lack of real interoperability, we are still printing more paper than ever...because notes are longer).
    The author describes the impact of allowing billing, coding, reimbursement, and "quality metrics" to commandeer the medical record. Less is More.