So, there I was yesterday, working frantically to keep myself above the water level of the rapidly rising swamp of patients.  Navigating, haltingly, the onerous and demonic EMR.  So I thought I ordered three nebulizers, but it was only one.  The respiratory tech approached me and informed me that she would put them in, but only this time. That I’d have to do them myself for a while to learn, or I’d become spoiled.  You know, spoiled.  That is, I might spend time with patients instead of the keyboard!

I don’t understand why it’s so much better for me to enter orders than for the secretary, or even nurse in some instances, to enter them.  Other people still vastly outnumber doctors in most departments.  Further, I still work in two places where I check the box on the form, or tell the nurse/secretary, and they enter it into the computer.

Why was that so bad?  Were there that many errors?  Were the secretaries that overworked?  Is the use of language, as in ‘Mr. Schwartz in room 5 needs CT angio to rule out PE,’ so utterly fraught with confusion and uncertainty?  Are physicians of such marginal value that we need to add tasks to the already challenging data entry and (secondary) patient care that we need to be trained to enter orders ourselves?  What’s next, perform our own CT scans, so we get it right?

And in an age of nurse empowerment, are nurses so unworthy of our confidence that they can’t do anything until it’s in the computer?  I swear, I expect to someday say ‘start CPR’ and be asked, ‘did you put it in the computer yet?’

We have crossed the line in the sand, passed the zero moment.  We have jumped the shark and all the other metaphors I can imagine.  Charting is bad enough, but I see nothing beneficial from having me sit at the desk and try to make decisions about life, death and disability, all the while trying to figure out how to enter a timed Troponin level, even as the next stroke victim rolls through the door.

‘Something,’ as my patients used to say, ‘has got to be done.’

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