I am getting too damn old and rather than the prior understanding with a knowing smile at the foibles of medicine, I find I am getting increasingly irritated.  It is a sure sign that I am getting to the end of my career.

 Maybe it is my increasingly discomfiture with the feeling that I never really know what is going on with patients.  People can respond to a perceived lack of control with many kinds of dysfunctional behavior including irratation.  Every other year I have to attend malpractice seminars as part of carrying malpractice insurance, and a lawyer mentioned in passing that the three big cases she was defending this year concerned misreading the EMR.

I believe it.  We are now all Epic, and in the torrent of tiny print and unneeded detail I have lost the ability to follow the narrative of the patients illness in the chart.  Given the ability of HCW s to personalize their progress note with volumes of imported garbage in any order they want, it is safe to say that after spending an hour reading the chart, I still feel uncertain that I understand the course of the patients disease.  The EMR is now for everything BUT communicating in a meaningful way about the patient.

I think there should be two notes for every patient: the computer generated note to document all the data you looked at to justify billing and a separate note that explained what is going on and why. The latter should take about a paragraph.  I spend a lot of time on computers, and there are real benefits to the EMR, but comprehending the patient s disease course is not on the list.