During our dermatology section in medical school, a classmate recounted having had Henoch-Schonlein purpura as a child. Over a holiday break, he visited his primary care physician and asked if he could review his records out of curiosity. His family physician pulled out the index card that served as this man’s medical record. Yes, you read that correctly. It was not a chart or computer printout; rather a 4 x 6 white index card, exactly like those we used in grade school.
My classmates’ name was written at the top of the card and on each line were dates and diagnoses. Halfway down were the words: HSP — “classic” rash. My classmate was disappointed he could not analyze his clinical presentation in more detail; nonetheless, he brought back a copy to show us. An index card as medical record tool is so extraordinarily simple; it is awe-inspiring. No insurance company to satisfy, no chart to be audited, and no computer screen between the physician and patient. Back then, a physician’s time was spent taking a history, performing a physical examination, and having a conversation.
My father has been a practicing pediatrician for the last 46 years. When I told him about the index card, he smiled and reminisced how much he loved index cards too; when physicians were compensated for practicing medicine and not just ‘documenting’ their practice. Combining the art and science of medicine is what many of us love most about being physicians. Why have we allowed bureaucrats and EMR systems to take away the very thing that brings us the greatest joy?
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