We physicians need a Ganesh attitude

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Category : Medical Rants

Over the years, I have had the great fortune to learn about different cultures and religions. I have many colleagues and residents who are Hindu. They have taught me about Ganesh. For those of you who do not know about Ganesh, this paragraph gives a summary:

In general terms, Ganesha is a much beloved and frequently invoked divinity, since he is the Lord of Good Fortune who provides prosperity and fortune and also the Destroyer of Obstacles of a material or spiritual order. It is for this reason that his grace is invoked before the undertaking of any task (e.g. traveling, taking an examination, conducting a business affair, a job interview, performing a ceremony,) with such incantations as Aum Shri Ganeshaya Namah (hail the name of Ganesha), or similar. It is also for this reason that, traditionally, all sessions of bhajan (devotional chanting) begin with an invocation of Ganesha, Lord of the “good beginnings” of chants. Throughout India and the Hindu culture, Lord Ganesha is the first idol placed into any new home or abode.

He represents intellect and wisdom. But the most important characteristic is Destroyer of Obstacles. Too many in medicine seem resigned to that train that has left the station. They sit around and lament what “they” are doing to “us”. They no longer consider fighting for changes.

Yet I see hope. I will admit to being an incorrigible optimist, but to me the signs are positive.

Performance measurement is changing. Bad performance measures are being changed and withdrawn. Many more “mainstream” thought leaders are advising a significant reconsideration of performance measure.

The enthusiasm of EHRs has waned. We now see an appropriate backlash. The ACP published an important letter yesterday in JAMA Internal Medicine about the impact of EHRs on outpatient practice – Use of Internist’s Free Time by Ambulatory Care Electronic Medical Record Systems

We all have a responsibility to not give up. We must speak out against administrative burdens that harm patient care. We should channel Ganesh and work to destroy obstacles to outstanding patient care. That is our responsibility. No excuses, no crying, no despair.

Comments (3)

Absolutely! Too often, physicians’ respond by walking away or not getting involved in the first place and all that does is leave those who are “doing it to us” in greater control. In the clinical domain, we don’t give up when faced with a challenging diagnosis or a disease that we cannot cure. We need to apply the same ethic that we use in taking care of patients to improving the practice environment: methodically consider all the possibilities, work towards a resolution of the problem, learn from our successes and failures, work with colleagues when necessary, and keep trying until we achieve the desired goal.

Bear with me as I go through just one example of the almost daily torture and disruption of lousy help and IT systems on physician workflow. The hospital where I work implemented a new EMR a few months ago. The incident that I am about to describe happened a few weeks ago. Of note I work in a Community hospital without interns, residents, med students, NP’s or PA’s. It’s just little old me. One morning ( while rounding) a few hours after admitting a patient, I received a phone call from the ER secretary telling me I would need to re input the admit orders as I had placed them under the wrong ” financial number”. I told her I had no idea what she was talking about as I simply clicked on the patient’s chart and placed the orders. I asked her to simply print off the orders I had already entered and manually input them under the correct ” financial number”. She told me she did not have time to do that ( as if I do) and besides it was my mistake so I would need to correct it. Livid, I hung up and called the house supervisor who also informed me it was my responsibility to correct my orders and the ward secretary and or nurse caring for the patient did not only not have the time but did not have the authority to do so. I reluctantly told the house supervisor ( grumbling I might add) I would re enter the orders but I did not really understand why this should be such a big deal for someone else to re enter them as this is how it was always done in the pen and paper world prior to EMR. I asked her to get the IT help person on the phone to report this issue and see how to prevent this busy work in the future. I tried to input the orders again but I couldn’t seem to find the right ” financial number” as stated to me by the ER secretary. The IT person called me back, helpful but clueless to the workflow of a busy MD. I told her about the issues and asked her if there was some way they could electronically migrate the orders from the wrong ” financial number” to the correct ” financial number”. She told me that the others were correct and that I would have to re enter the orders, they could not do that job for me and she could not migrate them electronically. I told her I could not seem to find the correct ” financial number” and she stated she would investigate and call me back shortly. A few minutes later she called and told me the good news. The registration person in the ED had not entered the correct number and so it was not my issue. They would fix the problem and yes they could migrate the orders electronically to the new number, not to worry. I was happy, sad, puzzled, angry and confused all at the same time. 45 minutes of my precious time to round and think on patients gone forever. EMR has ” dumbed down” the whole staff at the hospital. I used to have a ” team” of thinking individuals to help me care for increasingly complex patients. Now my team is down to two, me and the clunky EMR. God help us all.

I should have finished, Ganesh help us all!

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