THE BIGGER PICTURE: Dr. Incompetent

I am weary of how physicians are portrayed as incompetent in the popular and healthcare media, not to mention in national and local politics.

Witness all the chatter about physicians being "slow" to adopt electronic health records. A recent study of group practices published in Health Affairs, conducted by the Medical Group Management Association (MGMA) and the University of Minnesota School of Public Health, showed that 12 percent of practices have a fully implemented EHR. Another 13 percent have their implementation in process. Fourteen percent plan to install one in the next 12 months and another 20 percent expect to have an EHR implemented within 24 months.

In the press, this study was taken as proof that physicians will never get on board, or, at best, will accept technology only slowly. "Research Finds Low Electronic Health Record Adoption Rates For Physician Groups, USA," read the headline on Medical News Today. "Physicians' Use of EHRs Doubles But Remains Small," reported a Ziff Davis reporter on eweek.com.

However, according to my questionable journalist math, what this study actually says is that within two years 59 percent of practices will have an EHR. If the adoption rate continues at 15 to 20 percent a year, pretty much every practice will get rid of its paper charts around 2010 - right on track with President Bush's call for the country. This is a problem? The facts are twisted to fit the presiding perception of physicians as backward.

Indeed, the authors of the study take a somewhat less astringent stance than the press later ascribed to them. "[A] number of group practices plan to implement an EHR within the next two years," they note.

EHR adoption would probably be moving along even more quickly if the systems were less costly. The average purchase and implementation cost of an EHR is $32,606 per FTE physician, and maintenance costs another $1,200 per physician per month, according to MGMA's research. Practices usually end up spending about 25 percent more than the estimates they are given by vendors, the study found.

Perhaps the headlines should have read, "Physicians Wisely Wait for EHRs; Vendor Cost Estimates Low," "Physicians Make ROI on EHRs Despite High Cost," or "Physicians More Savvy than Thought."

But these narratives just don't fly in today's popular perception of physicians.

Take the recent New York Times article, "When the Doctor Is In, But You Wish He Weren't," as another example. It blasts insensitive, rushed, callous physicians with low patient satisfaction scores. The article described patient after patient insulted and even harmed by uncaring physicians and implicitly lauded health systems and payers cracking down. No doubt, some physicians could use a little help with their bedside manner, but such sensationalism makes it sounds as if most physicians are insensitive pedants.

One should hope we in the press would be a little less predictable and little more observant of reality, but don't count on it.

I say its time for physicians and those of us who write about them to change the story, to script physicians as the innovative smart people they are - before all of us stop believing it. What can you do? Maybe it's time to start writing your own stories. Write me - or your local paper - if you have a different sort of story to tell.

This article originally appeared in the February 2006 issue of Physicians Practice.