EHRs and burnout (a.k.a. early retirement)

Issue: BCMJ, vol. 58, No. 7, September 2016, Pages 363-364 Letters

A recent article in the Globe and Mail, included in a Doctors of BC newsflash, led me to write about electronic health records (www.theglobeandmail.com/life/health-and-fitness/health/doctors-using-electronic-records-at-higher-risk-for-burnout-study/article30652673/).

EHR adoption has not included provisions for transcription of pre-existing records/history. EHRs have been a boon for the regional health authorities in British Columbia—gathering of big data to allow further simplification of complex realities and ultimately leading to more homogenization and standardization of our (ideally) complex relationships with real people (patients) on the ground. Bonus incentives for management that are modelled on the corporate sphere make the mining of big data without a thorough understanding of the front-line complexities dangerous. With an agenda to make it easier to have the appearance of accountability and standardization of care, the data are often used to justify reduced real services on the ground and increased micromanagement.

I would hypothesize that in family medicine, burnout leads to a decreased ability to be our patients’ advocates in navigating the idiosyncrasies of nontransparently rationed care, less face time with patients, and more errors, thus justifying a need for more quality assurance and more idiot-proofing built into the EHRs, followed by a need for constant improvements (i.e., not intuitive patches that are usually inconsistent with the original operating platform), and resulting in EHRs that are even more rigid and frustrating. It’s a positive feedback loop and more business for the IT industry. The apparent smartness of drop-down menus and rigid algorithms have reduced flexibility and fit, as well as satisfaction and connection, which are essential in family medicine. Many of us may retire earlier than we otherwise would have, not because we don’t get it and are too rigid to learn, but rather because we do.
—Andre C. Piver, MD
Nelson

Andre C. Piver, MD, FCFP. EHRs and burnout (a.k.a. early retirement). BCMJ, Vol. 58, No. 7, September, 2016, Page(s) 363-364 - Letters.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply