The stupid stuff

March 5, 2019
Jennifer Frank, MD

The number of things we do in the business of medicine that have no direct bearing on patient health or well-being is astounding.

Editor’s Note: Physicians Practice’s blog features contributions from members of the medical community. These blogs are an opportunity for professionals to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. 

At a conference last year, I heard about an innovative program from Hawaii that a recent article in the New England Journal of Medicine describes. Called G.R.O.S.S, which stands for Get Rid of Stupid Stuff, the approach is disarmingly simple: Ask physicians and other providers to identify anything in the EHR that seems stupid or pointless. 

During the conference presentation, the speaker gave an example of a pediatric flowsheet that applied to patients from birth to age 18, which required documentation about the status of their umbilicus. That status is important information for newborns who still have an umbilical stump that is healing. But for all others it is inconsequential. (And would be relatively easy to fix in the EHR.)

Can you think of all the “stupid stuff” you do in a typical day both within and outside of the EHR? This is my list, in case anyone is willing or able to fix any of it.

1. ICD 10 took a simple ear infection and turned it into acute suppurative otitis media without rupture, recurrence not specified, left. If you are bitten by a farm animal, is it necessary for our coding system to differentiate between a pig bite and a cow bite? 

2. Prior authorization dances for tests we both know insurance is going to approve anyway. If my 80-year-old patient has a new onset severe headache without neurologic symptoms, I know and the insurance doctor knows that she’s going to qualify for an MRI. Why waste everyone’s time?

3. The list of 25 different ways the EHR lists 500 mg of metformin when I am trying to order it, virtually guaranteeing that I pick the wrong one.

4. Spending more time documenting what I did during a patient visit than actually caring for the patient.

5. Having insurance coverage for the preventive health service-screening mammogram, for example-but not for any of the diagnostic follow up testing when an abnormality is found. This discourages patients from completing their testing while leaving them worrying they have cancer.

Frustrations and challenges (“the stupid stuff”) are a major issue in most professions. However, in medicine, it sometimes seems like we go out of our way to create stupid stuff-stupid rules and regulations, unnecessary complexities, idiosyncrasies of insurance coverage that make it impossible to figure out what something actually costs, and an EHR that operates more like a Commodore 64 than an iPhone.  

The number of things we do in the business of medicine that have no direct bearing on patient health or well-being is astounding. The first step in change is calling it what it is-stupid stuff.

Jennifer Frank, MD, is a family physician and physician leader in Northeastern Wisconsin and finds medicine still to be the best gig out there. Married with four kids, she is engaged in intensive study and pursuit of work-life balance.