BOSTON, MA – Dr. Earnest DeYoung, a promising intern at Backwater Junction General Medical Center, admitted Mildred Dweendles to intensive care late Friday night. Dr. DeYoung spent 54 seconds with the patient but two-and-a-half hours with the computer working on the admission in the hospital electronic medical record (EMR).
DeYoung missed Mildred’s dead bowel, septic shock, renal failure, and cardiac tamponade, but, following what he understood to be Proper Protocol for Quality Patient Care in the Digital Age of Medicine, he checked many pointless boxes.
He swiftly dispatched the Medical Necessity Documentation from Medicare. First things first! Adroitly, he authorized protocol plan of care orders including Appropriate Lighting and the crucial Wipe Butt order so the nurse would know what to do if Mildred pooped. (No mystified ICU nurse was gonna page him at 2 AM!)
Then, to satisfy the med-wreck, he reordered Mildred’s home medications, including digoxin and potassium. To address Fall Risk, he clicked Switch Gravity Off. The Quality Care Metric in the corner of the screen inched higher with each electronic physician-entered order.
When the EMR cleverly suggested a worrisome interaction between sodium chloride and water, Dr. DeYoung artfully allayed its concerns. He ordered an Ambien tablet prn and, scrolling through a long alphabetical list in a tiny box, chose the route of administration from options including intraocular, presacral, and transcholedochal.
He picked a prn reason for Ambien (more scrolling in a tiny box) from a list of such favorites as Itchy Eyes, Erectile Dysfunction, and the ever-popular After Bowel Movement. What fun! He was hitting his stride now.
He finessed the system’s complaints about lack of DVT prophylaxis even though he’d already ordered subcutaneous heparin. He ducked the Positive Pregnancy Alert (Mildred was 82-years old) and eluded the Ebola Travel Risk Alert (and a nonambulatory amputee). He didn’t mind these clueless quirks, these mindless obsessions, these inane oddities; having nothing better to attend to, the game of neurotic nonsense excited him.
He updated the immunizations and, ninja-like, dodged red flags about the absence of verified body weight and Mildred’s personal gender identification. The cadence of the alerts was like the song of a siren.
He deflected medication allergy cross-reactions from AAbilify to ZZyvox. Every drug, according to the system, cross-reacts with all others. He clicked boxes about code status, and sexual preferences past and future. He was good at patient care; it was like a dance, and the beat was entrancing! He specified Mildred’s religious affiliation and documented her shoe size and toenail thickness for her remaining left foot only. He clicked entries for problem lists and chose ICD-10 codes. Then more ICD-10 codes, then more… Surely such incantations would appease the gods of Meaningless Ruse!
A contented purring came from the hard drive as the young doctor’s deft keystrokes rhythmically clicked the boxes. Rarely had anyone met the system’s needs with such grace and fluidity. So many doctors fought the relentless assimilation, but here was one, finally, eager to drink the cup of KoolAid (or hemlock?).
DeYoung blushed as the software beckoned to him; he could feel a change in the tempo of its coy system delays. His heart rate and breathing quickened. (So did Mildred’s.) He shifted in his chair and ran his finger delicately over the mouse, caressing left click and right. The software alerts came more quickly, and their gratuitous scarlet borders looked thicker and redder. With each alert and response, each advance and rebuff, each thrust and parry, DeYoung became more certain that this admission, this Deep Dive with Data, would be for Destiny.
Meanwhile, unfortunately Mildred went to hers.
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