Some clinicians are better than others. Surgeons and radiologists are notoriously brief, with rare exceptions. There is a certain infectious disease specialist at my hospital that writes so voluminously and well that I feel like I am sitting at the bedside of the patient I am puzzling over. There is a big difference in the large hospital I am primarily based at versus the small town hospital I rotate at once a month. In the smaller town, clinic notes are piped into the hospital medical records (must be easier there to do this I guess - less clinics, less complication) so I can access outpatient records - the clinician's thoughts can illuminate a tough GI biopsy and make it so much easier. It saves me lots of headaches and phone calls.
Performing wet reads on CT-guided needle biopsies in radiology is a particular sore spot. I know the radiologists are busy - drain an abscess here, do a paracentesis there, squeeze in another needle between a couple of radiofrequency ablations. But I still get irked when called to a lung biopsy and the radiologist doesn't know the history. I know, I know, I don't have to worry about causing a pneumothorax and putting in an emergent chest tube or dealing with a pulmonary hemorrhage - and they do. We all have our places in the cog of the medicine wheel. Thankfully, with EMR, I don't have to worry about what the clinician did or did not communicate to the radiologist - I can just open up the computer and get all the information I need to know. Information aids diagnostic accuracy, and ability to triage the specimen appropriately.
Take for instance the other day. I was sitting in my new (beautiful - yes still a closet in a lab, but with brand new coppery Formica and linoleum hardwoods that render me the envy of all the other pathologists) office and grabbed a CSF (cerebrospinal fluid) case. The cytotech screened it and called it negative. 90-95% of the time they are right. I picked up the cytospin, threw it on the stage, and looked in the scope. Low cellularity -appropriate for a CSF - a few lymphocytes and monocytes. But wait, what was that? A plasma cell? Plasma cells are never normal in the CSF. Often they herald chronic inflammatory issues or viral illnesses. I opened the EMR on the patient.
This patient had a diagnosis of plasma cell myeloma with recent acute mental status changes. So the lone plasma cell or two I was seeing, among the lymphs and monos, could indicate leptomeningeal spread of the patient's disease process. I reversed the tech diagnosis to atypical and added a lengthy comment - unfortunately there weren't enough cells to attempt flow cytometry to assess for clonality of the plasma cells to cinch the diagnosis. But with the information in the EMR I was able to get a more holistic picture on a couple of cells and provide better care for the patient. I cringe to wonder if I might have blown them off as lymphs without my crutch.
I open the EMR every day, all day, on almost every patient. In the rare instance that I see cancer in a specimen where there is no clinical or radiographic suspicion, I can take extra measures to ensure that I have the correct specimen and gain additional consults to firm up my suspicions. I am a pathologist, but with EMR, I no longer live in a black box. And for that, I am thankful. I really don't know how my predecessors got along without it.