Writing a letter to your confirmation candidate

It seems that one of the biggest events in confirmation preparation in this country is the letters of support to be given to the confirmation candidates during their mandatory retreats.

I have three such letters saved on this blog:

Confirmation letter to my daughterConfirmation letter to my fourth sonConfirmation letter to to my third son
I've asked my children what they remember about the letter they got from me and their dad, and also what they remembered about the letters they received. 
The answer was not much, or at least nothing specific. In general they were happy to have gotten a bag full of letters and there was a sense of feeling loved and supported. I guess that's the main thing - for them to have a sense that this is an important step in their spiritual growth, and that people they know, love and respect have taken the time out of their lives to let them know that! So here are some tips on procuring and writing letters for young confirmation candidates. Start thinkin…

Medical Transcription and the Electronic Medical Record - three years later.

I last blogged about this three years ago in 2015. 

A few years ago, I wrote my observations about physicians' offices and how they are handling entering patient information into the electronic medical record.

I have noticed at the last few doctors' visits I have had, either for the kids or myself, that the doctor's laptop gets more face time than I do. My doctor is kind of new to the technology and I swear half of our time was eaten up with trying to figure out the computer interface.  And I understand it's going to get even worse as Obamacare takes over. I even joked with my doctor as she was typing my words into the tiny box they gave her at the top of her screen, that she was doing my job!

It seems to me that in the interest of saving money, the powers that be have removed the medical transcriptionist, who made probably between $15 and $25 dollars an hour, and given that responsibility over to the doctor.  So a person who went to college and then medical school is doing this clerical job.  I can't wrap my mind around how this is supposed to be cost effective or good for patients??

and this

In my personal experience over the past five years, I find the health care providers I see (or that see my children) spend as much or MORE time with their attention to their lap tops than they do face timing me. During my last review of systems, the doctor was whizzing through the questions so quickly I hardly had time to think before answering.  Ironically, the provider that gave me the most care in terms of having an actual conversation, was the podiatrist!

But last week I had the most interesting office visit. An LPN took us back to a room and asked the usual questions, and then she started typing into the laptop.  She wasn't just checking off boxes or filling in a template, she was actually typing the report.  She called it, "free typing."  As a medical transcriptionist, we were NEVER EVER allowed to just make stuff up, let alone compose a report by ourselves!  Yet here was a licensed practical nurse (whom I might add typed considerably less than 100 wpm) doing just that.

Oh, and I got the honor of sitting in the room watching her type the report too, which added 5 to 10 minutes to the total visit time. In the olden days the patient didn't even see the person typing his medical report let alone have to wait in the same room while it was being done!

Time saving?  No.  Cost effective?  Probably not.  Those 5 to 10 minutes per patient add up.  Probably one or two more patients could have been seen at the end of the day if the room wasn't occupied for records created by the care provider.

I was a medical transcriptionist for almost 30 years, working mostly for doctor's offices and clinics although I did do work for a rehabilitation hospital for a time as well. After high school, I went into a medical assisting program and then after a few years, I also completed work to become a registered medical records technician. I had a lot of coursework in anatomy and physiology as well as medical terminology, disease pathology, and pharmacology. I can also type over 100 words per minute. Medical transcription was a good job for me and at the time it was also a respected and well-paying profession.

Those days are over.

In my personal experience over the past five years, I find the health care providers I see (or that see my children) spend as much or MORE time with their attention to their laptops than they do face timing me. During my last review of systems, the doctor was whizzing through the questions so quickly I hardly had time to think before answering.  Ironically, the provider that gave me the most care in terms of having an actual conversation, was the podiatrist!

NEC Corp of America via Flickr  Licensed by Creative Commons

On another note, although the EMR is probably going to get rid of medical transcription as a profession, it has created a new job - that of Medical Scribe.  Oh, but it's not an associate degree or even a BS degree-type skilled job.

No!  This person follows the doctor around and enters the information into the computer for him or her.  I've seen they prefer medical students, but apparently also others.  They even have their own accreditation - for what is basically a data entry job. Was that really a cost savings?  I doubt it.

Now some physicians are beginning to question all of these documentation changes as well. 

It happens every day, in exam rooms across the country, something that would have been unthinkable 20 years ago: Doctors and nurses turn away from their patients and focus their attention elsewhere — on their computer screens.
By the time the doctor can finally turn back to her patient, she will have spent close to half of the appointment serving not the needs of her patient, but of the electronic medical record.
Electronic medical records, or EMRs, were supposed to improve the quality, safety and efficiency of health care, and provide instant access to vital patient information.
Instead, EMRs have become the bane of doctors and nurses everywhere. They are the medical equivalent of texting while driving, sucking the soul out of the practice of medicine while failing to improve care.

Is there hope of this all reversing itself?  Probably not. Last year it caught up with me. The physician I worked with for almost 25 years let me go. The hospital had been taken over by the Cleveland Clinic and he had no choice but to go with the electronic medical record. All my training and experience couldn't save me. I am obsolete.

Even if Congress rolls some of the (Un)Affordable Care Act back, hospitals and doctors have invested a lot of time and money in the new technology. It's nog going away.

There might be a few perks for patients though. They might have a chance to text more information - it not to an actual person.

iphone app in the UK. 

Lab results via smart phone

If you like your doctor you can keep your doctor - just don't expect to have a conversation with him/her.


  1. Holly4:34 AM

    What existed before electronic records? I'm guessing hand written notes? So surely doctors had to take their eyes of theur patients to take notes back then too.
    My typing is about 2-3 times faster than my handwriting, and I'm guessing is probably true of most people born after 1980 or so. It's never a nice thought that people are out of work, but as older doctors (less confident typers) retire and are replaced by younger doctors this probably will be more efficient.

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  3. The other thing about those EMRs is that I'll bet dollars to doughnuts many are inaccurate. I read medical records for a living and while I am thankful to be reviewing typed pages rather than doctor's scrawl, in the old days your ENT did not document that you had no muscle spasms in your neck or back. Today he or she probably does, by default. In other words, the template on the record says no muscle spasms, and unless the doctor changes it, that's what it says. However, the chances are that your ENT never looked at your neck or back.


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