One of the things that interns almost everywhere grapple with is paper. Mounds and mounds of paper. Salmon colored paper with stripes to fill out progress notes, bright green paper with neat rows of checkboxes for ordering scans, tired-looking, off-white paper for discharge instructions that you can only write on with a ballpoint pen (to make sure the imprint comes through on the eight sheets of carbon paper underneath.) Forms for home health care, forms for skilled nursing, forms for prescriptions, forms for antibiotics, forms for X-rays. Templates, sign-out sheets, post-it notes ("DON'T FORGET to check Mrs. Smith's creatinine at 3 pm." or "Chinese food in the 6 Mezz conference room! Be there!").
The minute the intern gets a page that a patient is about to be admitted, there is a mad dash to get the paper in order. The big blue binder is brought out, the tabs ("Medications", "Physician Orders", "EKGs", "Demographics") neatly laid in place, a rainbow of papers hole-punched, stapled and stamped with the patient's name. This is the patient's Life in The Hospital, the famous site of unintelligble physician scribblings, tentative orders by interns (with the trademark scratch-outs and revisions), medications and progress notes.
And then the patient becomes an official part of the intern's personal roster. This is the intern's Life in the Hospital, her most dearly protected possession (second only to a non-leaky black ballpoint pen), containing such vital facts as each patients' hemoglobin count, latest echocardiogram results, past medical history, name and age, the all-important "TO DO" list, that kind of thing. Each intern's system varies, but have the following requirements:
After he left, the technical support staff came to do their presentation on the new electronic recordkeeping system to which our hospital is beginning to transition. "We've prepared a comprehensive handout for you so that you physicians have the info at the tips of your fingers," the staffmember beamed, as he passed out thick, single-sided handouts to each of us. We added the Learning to Use the Electronic Database handout to our orientation folders, which would, by the end of the week, bulge with the company of various other stapled paper counterparts: Cultural Diversity in the Physician Workplace; What To Do When A Physician Needs Help; Nurses and Physicians - Working Together for Better Health; Information Security Cares About You.
Maybe a paperless hospital is possible. But as I print out my patient roster e
very morning, order Mr. X's CT scan using the white form (not the yellow form, which is for EKGs, and not the green form, which is for consults only), write my hopefully legible progress note in the pink section of the patient's chart, silently curse the computer that inexplicably prints out three copies of Mrs. Y's history and physical when - I swear - I just asked for one copy...I sometimes wonder whether hospitals and recycling companies have a secret contract that has to expire first.
Time for me to go plant a tree.
The minute the intern gets a page that a patient is about to be admitted, there is a mad dash to get the paper in order. The big blue binder is brought out, the tabs ("Medications", "Physician Orders", "EKGs", "Demographics") neatly laid in place, a rainbow of papers hole-punched, stapled and stamped with the patient's name. This is the patient's Life in The Hospital, the famous site of unintelligble physician scribblings, tentative orders by interns (with the trademark scratch-outs and revisions), medications and progress notes.
And then the patient becomes an official part of the intern's personal roster. This is the intern's Life in the Hospital, her most dearly protected possession (second only to a non-leaky black ballpoint pen), containing such vital facts as each patients' hemoglobin count, latest echocardiogram results, past medical history, name and age, the all-important "TO DO" list, that kind of thing. Each intern's system varies, but have the following requirements:
- MUST fit in a pocket that is already crammed with various sundries (pocketbooks, gum and pens). Big clipboards and other such fussy items may look organized, but like any short-lived fashion trend, they will soon lay abandoned in a forlorn corner, languishing near a stale donut and the June 2006 issue of US Weekly magazine.
- MUST allow for fast retrivement of basic data. You do not want to enter room 6442, turning to face the patient with what you hope is the air of a confident, knowledgeable physician exuding empathy and compassion, only to realize you have completely forgotten which patient is in 6442 and have to scramble frantically through your size 2-font printed sheets to find this basic information. Big printed name = Good.
- MUST have plenty of space for scribbling. This is important. Interns run around hallways all morning and afternoon, with the vague, disturbing sensation that they have forgotten something Important. The only way around this is to checklist, checklist, checklist; write down; write down; write down. Thus, "Hey - can you make sure to call Mr. X's daughter to update him today?" or "You know, Doc, I really need a bedpan, and I've asked the nurses ten times to get me one but they haven't" or "Doc, Can you find out if the cafeteria serves grilled cheese on Tuesday evenings after 5?" each take on the anointed status on the intern's roster of Written Down/Box To Be Checked Off. It makes the intern's life supremely easier if all of those boxes and tasks are written in the same organized place as opposed to, say, the back of one's hand, a random grocery receipt, a crumpled dollar bill, the hem of a white coat. (And can I tell you: at the end of the day, looking at all those checked-off boxes feels like an accomplishment in itself...)
You can get fancy: pocket-protector types may be seen carrying around those brightly colored index cards, neatly alphabetized, segregated by patient condition and date of admission, finished off with a smug little binder clip or binder ring to - can you believe this? - hold everything together. More, um, creative, stream-of-consciousness types like, um, me (I'm still trying to get myself to stop writing my to-do's on the back of my hand) rely on the ever-classy Sheet of White Paper Folded in Half (it is classy - doesn't that sound like the title of a still-life portrait?) complemented with Supplemental Scribblings on Other Sheets of Random Papers in Coat Pocket.
Of course, such a roster adds yet another exciting element of paper to the intern's life.
The hospital at which I'm doing my residency proudly proclaimed, on our first day of orientation, their mission to go "paperless". The speaker talked of a utopia where everything would be clickable, cut-and-paste-able, retrievable remotely, wirelessly and infra-red-lessly. Physicians would carry their all-important roster on a PDA or TabletPC, charts would show up on computer screens. "I have a dream," he intoned into the sterile hospital air, "that one day, the single push of a button will bring a physician all the important data on the patient...where paper" - he spit out the word like it was a piece of over-chewed gum - "where paper will no longer exist inside the walls of this building."After he left, the technical support staff came to do their presentation on the new electronic recordkeeping system to which our hospital is beginning to transition. "We've prepared a comprehensive handout for you so that you physicians have the info at the tips of your fingers," the staffmember beamed, as he passed out thick, single-sided handouts to each of us. We added the Learning to Use the Electronic Database handout to our orientation folders, which would, by the end of the week, bulge with the company of various other stapled paper counterparts: Cultural Diversity in the Physician Workplace; What To Do When A Physician Needs Help; Nurses and Physicians - Working Together for Better Health; Information Security Cares About You.
Maybe a paperless hospital is possible. But as I print out my patient roster e
very morning, order Mr. X's CT scan using the white form (not the yellow form, which is for EKGs, and not the green form, which is for consults only), write my hopefully legible progress note in the pink section of the patient's chart, silently curse the computer that inexplicably prints out three copies of Mrs. Y's history and physical when - I swear - I just asked for one copy...I sometimes wonder whether hospitals and recycling companies have a secret contract that has to expire first.Time for me to go plant a tree.
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I hope things are going well. It seem that you're getting a handle on things. ~Flora
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