October 15, 2018
Reposted with permission; originally published February 2018, https://doi.org/10.1111/jgs.15293, as an “Old Lives Tale” for the Journal of the American Geriatrics Society. “Old Lives Tales” share the stories and experiences that have instructed, saddened, or gladdened geriatrics health care professionals and, above all, taught us something about the care of older people. For more information, visit https://onlinelibrary.wiley.com/journal/15325415. © American Geriatrics Society
By John R Burton, MD
In clinic, I was running 20 minutes behind when I got to my last patient. I apologized for the delay and started to address her six concerns. She was 70 years old and a retired health professional, and I had been her primary care physician for 35 years. She had experienced two heart attacks, hyperlipidemia, statin intolerance, hypothyroidism, chronic ovarian cyst, arthritis of spine and hips, glaucoma, and sustained grieving after losing her parents (both my patients), for whom she cared in their final years. Typically, she researched every symptom, and came to every visit with her husband and a prepared written list of questions and concerns.
As we concluded the visit, I typed discharge instructions, orders for a laboratory test and follow‐up information into the electronic health record (EHR), when her husband asked a question. I was in the middle of selecting a diagnosis from a dropdown list to justify the test, and I hit the “Accept” button as I turned to answer his question. After answering the question, I refocused on the wrap‐up and referred her to the laboratory for a blood draw. She then checked out and received the printed summary of the visit. As it turned out, I had inadvertently selected the diagnosis “Walking Corpse Syndrome” from the dropdown list.
Once home, she and her husband were astounded to read the diagnosis of “Walking Corpse Syndrome” on the visit summary. They called the office, panicked and obviously upset. The office receptionist found me immediately. I had no knowledge of this syndrome and spent several minutes on the phone explaining that it was an error caused by my inadvertently pressing the “Accept” button.
She said she understood, but I sensed that she felt I somehow had been hiding a diagnosis from her for some time. She called again the next day to review the situation after researching the diagnosis. I called her several times over the next week to be sure she accepted my error and apology. Over the following months, on subsequent visits, I spent time in conversation with her and her husband to reestablish the integrity of our patient‐doctor relationship.
After the first panicked call, I had researched the diagnosis and called a senior psychiatrist who also had not heard of “Walking Corpse Syndrome” (a rare mental illness in which the patient has a delusion that they have died), yet the diagnosis was listed first on the dropdown list to justify the laboratory test.
The widespread adoption of EHRs over the last decade has created major changes in the way clinicians work and relate to patients. I am embarrassed by my error, and to avoid a similar experience, I inform my patients when I must concentrate on the computer for critical data entry moments. I also dictate my note with the patient listening so they are engaged in that part of interaction with the computer. I hope the EHRs of the future will become less cumbersome.
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