Why This Concierge Practice Prefers Paper Records

One of the more persistent vendors to solicit my concierge medicine practice are those for electronic medical records systems. They are “shocked” that I prefer to keep paper rather than electronic records in my office.

To be frank, I’ve been amazed by the stupidity of many physicians and politicians who believe that electronic medical records are cheaper, more efficient or somehow superior to a paper record. Finally, someone with a technology and business background agrees with me: Why Tech Can’t Cure Medical Inflation.

Electronic records will not solve any of our escalating medical costs. Forbes’ Lee Gomes strongly disagrees with President-elect Obama that electronic medical records will somehow save the system 80 billion dollars per year. Instead, Gomes suggests that electronic medical records may actually make things worse, by adding more “boxes to check,” thereby increasing the number of billing codes used by physicians and their coders.

Gomes hits the nail on the head with the following analysis: “Instead, the heart of the problem is the U.S. fee-for-service system, in which doctors get paid to do things to people. The more technical and invasive the procedure, the more money they make. Doctors have responded in the expected Pavlovian manner, collectively shifting away from basic primary care toward expensive specializations that run up costs without necessarily improving medical outcomes.”

I couldn’t agree more. As the primary care shortage reaches crisis proportions, medical care will get more fragmented and more expensive. A system that imposes an electronic record system will do nothing to improve this crisis. Furthermore, those doctors who adopt electronic systems will have medical records that will be little more than templates for diagnostic codes – leaving out important individual elements in the patient’s history, along with a loss of documentation of the physician’s critical thinking.

At present, politicians hawking healthcare reform and drafting nation healthcare legislation are doing little more than paying lip service to the shortage of primary care physicians. The idea that medical students are going to flock to primary care if their loans are forgiven for several years of primary care service – as has been done in the National Health Service Corps – is ludicrous. This may drive a few students at the bottom of the class into primary care, but cannot do the same for attracting the best and the brightest. On the other hand, practice models like concierge medicine, where primary care doctors can earn a salary that is on par with what a specialist earns, WILL improve the primary care shortage. More primary care doctors practicing cognitive medicine, as opposed to procedural medicine, will not only help curb medical inflation, will also result in better care for patients.