For the past quarter century, hospitals have fostered an institutionalized form of co-dependent behavior on the part of nurses, medical transcriptionists, and office staff who dutifully protect careless doctors by surreptitiously rectifying the doctors' documentation errors while making sure that nothing happens that might upset the physicians.
That "human safety net" has slowly and steadily been evaporating as a result of recent cost-cutting measures. Many of the support staff who routinely took it upon themselves to fix a doctor's mistakes have retired, been laid off, or decided that they're simply not being paid enough to assume that kind of responsibility. In some situations, their jobs have been eliminated as transcription has been farmed out to offshore transcription services or transcription services that use speech recognition engines as a back-office means of processing dictation.
Although few people think of this as a risk management issue, the brutal reality is that it represents a disaster just waiting to happen.
The four basic ingredients for a risk management time bomb (which can be found in almost any hospital in America) are:
- Doctors with impaired language skills who suffer from a "vulnerability of vocabulary."
- A large number of mistakes that have been dictated, but have not been caught.
- Hospital administrators who are more concerned with the cost of transcription services than accuracy.
- Doctors in denial whose poor people skills prevent them from hearing and accepting criticism.
While health information management professionals have endured knock-down, drag-out administrative battles trying to keep the first three ingredients under control, they have been absolutely powerless against the fourth.
"Docs naturally resent paperwork and will do anything to get out of it; they resent hospital staff who try to get quality documentation out of them," complains the Medical Record Director of a 375-bed hospital. "Doctors really don't give a hoot until they get slapped with a lawsuit. It's about time someone gave these docs -- and hospitals -- a good, stiff kick in the pants."
Denial (as they say in many 12-step programs) is not just some river in Egypt. It is, in effect, why all the industry talk about healthcare reform, cost controls, and the need for Total Quality Management (TQM) becomes a cruel joke when hospital administrators refuse to acknowledge one of the most critical problems in the health information management industry -- the medical mush that emanates from the mouths of dictating physicians.
Next: The Patron Saint of Dictating Physicians
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