Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, December 31, 2008

Paper Rainbow Memories

I've mentioned before that I don't use an electronic medical record. My paper charts serve my needs adequately. I've designed my own system with colored folders, based on the second letter of the patient's last name, that's kind of nice to look at as well as being quite functional. Still, paper charts do require some annual maintenance.

In addition to labels identifying the patient (and sometimes the insurance) there is a sticker on the end of each chart showing what year the patient was last seen. Patients seen within the last three years are considered "active," so we keep their charts on the most easily accessible shelving. Charts of patients not seen for seven years are considered inactive, but we keep them nearby in case they call and want to be seen again. After seven years, we move the charts to "cold storage." Technically this is allowed to be off-site, though I have plenty of storage space in the basement of my office, so that's where they go.

What this means is that once a year someone (me, in this case) goes through all the active charts and pulls those of patients who haven't been seen since 2005. This task is made easier by the fact that the end-tab stickers for each year are a different color. They repeat over a cycle of 10 years: black, yellow, blue, pink, brown, orange, olive, green, gray and red. I'll be starting on my third round of them in 2009. Before I do that, though, I have to make room by moving the charts of people who haven't been seen since 2000 down to the basement. Then I can move the 2005's over to the inactive shelves, and enjoy the relative increase in the amount of space available for regular least until they get packed in again with new patients and more records on old patients in the New Year.

So as the year draws to a close, I find myself hanging out alone at the office finishing up these annual chores. Hardly anyone wants to be seen, so the staff is out. I find that being here to answer the phones cuts back on messages and frantic calls later on; besides, there's work to do.

It's great exercise running up and down the steps a dozen or more times lugging armfuls of charts and rearranging them on the shelves. In the process, of course, my eye scans over the names and, cursed blessed with an elephantine memory, thoughts of the people behind the paper come back to me. I remember them; their illnesses and their medical histories, but also what they were like as people. Some I liked; others not so much. We are all only human after all. But over the years, many of those patients and I truly became friends.

Wow, I think; has so-and-so really been dead for eight years now? His grandchildren are getting so big; they miss him, and so do I.

Oh yeah, that family moved away. I wonder how the kids are doing. My goodness; the "baby" must be in school by now!

On and on, twice through the alphabet plus whatever it takes to shuffle them around evenly on the shelves. The tips of my fingers split and bleed from dozens of paper cuts and the muscles in my hands begin to ache from moving handfuls of charts at a time. As I work, I find myself looking back, remembering not just the year gone by, but all my years in practice.

When my task is done, I stand and regard a wall of color. Narrow stripes of it superimposed on larger blocks, together representing so much: sickness and health, life and death, all arrayed before me in rainbows of memory. Even though I saw the patients one at a time, generated the pages in those folders before me word by word, visit by visit, day by day over each of all those years, now I stand and gaze upon them in aggregate. So much more than just words on pages, each of those folders is a record of a person whose life touched mine and whose life I was privileged to be a part of, hopefully influencing it for the better. And I find myself profoundly grateful to each of them for that opportunity.

I smile to myself as I turn out the lights and head for home, wondering how long the charts will stay so nice and neat on the shelves like that.

Happy New Year!


At Wed Dec 31, 11:32:00 AM, Anonymous Anonymous said...

Nostalgia, productivity, and a workout--how wonderful!

At Wed Dec 31, 11:44:00 AM, Blogger Sara said...

I really liked this was pretty, in a strange way. All the charts, lives, people.

At Wed Dec 31, 01:24:00 PM, Blogger rlbates said...

Happy New Year to you and yours!

At Wed Dec 31, 02:29:00 PM, Anonymous Anonymous said...

A really slick system. Gives a new meaning to the 'at a glance' claims of the techno-whizbang EHRs that are out there now.

Chuck Brooks
FutureWare SCG

At Wed Dec 31, 05:24:00 PM, Anonymous Anonymous said...

Cool...this is medical records as I remember learning about it in college. I got to thinking about the total difference between paper records and EMRs one day when we were over at the hospital Xmas party, because oddly enough, the hospital itself still uses paper records, while the doc offices I code for that are part of the same healthcare system use an EMR. I can see the advantages and disadvantages of each system; sometimes "technology" isn't all it's cracked up to be.

At Wed Dec 31, 08:43:00 PM, Anonymous Anonymous said...

While I could never do primary care, I am jealous of your experiences with your patients.

At Wed Dec 31, 09:36:00 PM, Blogger D.P. said...

Happy New Year!!!!!


At Wed Dec 31, 10:37:00 PM, Anonymous Anonymous said...

Well, Hell, Dino.

If you'd needed help, I'd have brought a couple of bottles of wine and some munchies, worn some grubby clothes and helped.

At Thu Jan 01, 05:31:00 PM, Blogger Margaret Polaneczky, MD (aka TBTAM) said...

No EMR system is as good as what you've got.


(Happy New Year)

At Fri Jan 02, 01:00:00 PM, Blogger Stefan said...

What a beautifull post.
Become friends with your patients, wow.
This kind of posts remember me why I want to study medicine next year!

At Sat Jan 10, 11:53:00 AM, Anonymous Anonymous said...

You do that yourself? In my first job in medicine, I spent ALL of my time purging the old charts, filing dictations in the current charts, and determinedly hunting down the continuously lost charts.

I'll admit they're pretty to look at, but after later being an MA for nearly four years at a clinic that uses exclusively EMR, I'm not particularly fond of the paper charts. Maybe I'm just scarred.

All that aside, this is a very well-written post that artfully illustrates some of the thoughts and emotions I've only barely felt or tasted, but which embody much of the reason I'm going into medicine, specifically primary care.


At Tue Jan 13, 05:26:00 PM, Blogger MadMT said...

Beautifully written. As an MT I miss paper charts, too. EMS and HIPAA have screwed up my profession, too.


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