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Unintended Consequences Of Standardizing Physician Practice

Mon, 09/26/2011 - 9:32am
Steve Wilkins, MPH

Turns out there is an unintended consequence of many of the current efforts to standardize the way doctor’s practice medicine.  It is called de-skilling.  De-skilling can occur when physicians and other providers try to adapt to standardized, new ways of doing things.  Examples of such standardization include clinical based care guidelines, electronic medical records (EMRs), pay for performance (P4P),patient centered medical home (PCMH) requirements and so on.

Examples of physician de-skilling were revealed in a recent study which consisted of in-depth interviews with 78 primary care physicians regarding EMR use.  EMRs are all about standardization – what data is captured and recorded, how data is reported, how data is used, and so on.

Over the course of the interviews, physicians in the study described significant examples of de-skilling behavior.  Most indicated  that valuable patient information was being lost given how physicians adapted to using the EMR.  Why?  The physicians believed that the EMR forced them to change how they “fed their clinical thought processes into a patient’s record.”

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