Massachusetts Medical Society: Medical Record Challenges — A Subtle Sign of a Potentially Impairing Condition?

Medical Record Challenges — A Subtle Sign of a Potentially Impairing Condition?

Physician Health Matters

Vital Signs: December 2011/ January 2012

Doctors learn early in their training that one important and unavoidable part of their job is to complete medical records in a timely fashion. As house staff, their paycheck may be withheld for failing to do so; as attending doctors, they may lose admitting privileges.

Complete, accurate, and up-to-date records are critical to patient care, especially since nowadays nearly all records are kept electronically. Complete records are also an integral part of hospital accreditation and are important medical-legal documents.

When something so necessary is not getting done, it is prudent to explore what else might be going on.

Newly manifested problems could indicate other serious issues:

  • Depression. The physician may be feeling fatigue or a sense of worthlessness, or just be unable to get much done except the most crucial patient care tasks.
  • Anxiety. As charts pile up, a physician can become paralyzed by anxiety so that they are unable to even begin work on them.
  • Stress. Almost any issue can preclude the completion of work. Personal issues such as divorce, illness, financial problems, a malpractice suit, or workplace conflicts can interfere with work. Many doctors are not willing to openly discuss such issues with colleagues.
  • Medical issues. The physician may be struggling with memory issues such as those caused by early dementia or a condition such as multiple sclerosis, diabetes, or other chronic illness that can diminish strength. To make matters worse, the physician may try to cover it up.
  • Substance abuse issues. Another possibility is impairment due to drugs or alcohol or the anxiety that comes with hiding such a problem.
  • Overwork. During a shift, a physician sees patients, orders tests, and prescribes medication, but often what is left for later is the chart work. If the pace of a practice is ill suited for a physician, lack of record keeping may be the first sign. A physician might be reluctant to admit that they just can't keep up.

Dr. John Wolfe, associate director of PHS, encourages referral to PHS, explaining that "getting behind on medical records is an objective measure of possible trouble." With the new era of hospitalists, doctors, especially PCPs, are more likely to be isolated, with problems going unnoticed until the problem is larger, he said.

Dr. Jacquelyn Starer, PHS Clinical Advisory Committee member, said, "A doctor's response, behavior, and attitude when approached about medical record completion may be useful in suggesting whether other issues are involved, such as depression, anxiety, substance abuse, personality disorders, or personal circumstances."

Most hospitals and practices have internal mechanisms for addressing incomplete records. When the problem persists, administrators may begin to "confront or sanction" the physician. Often this does not produce results, and it may even make the problem worse. A referral to Physician Health Services, Inc. (PHS) might help sort out the issues. If you or a colleague need assistance, call PHS at (781) 434-7404. For more information, visit the PHS website at www.physicianhealth.org

- Judith Eaton, M.D.

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