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BJOG Editors’ Choice: ‘No Screens, No Money’ Proclaims Fats


Thorp, John M., Jr. (2020). BJOG Editors' Choice: 'No Screens, No Money' Proclaims Fats. BJOG: An International Journal of Obstetrics & Gynaecology, 127(6), 653.


Samuel Shem satirised the US healthcare system with its excesses and dangers in his novel Man’s 4th Best Hospital, following up 40 years after his biting commentary on residency in his novel The House of God. His characters from the first text reappear in mid‐life, including the legendary ‘Fat Man’ who continues to dispense his wisdom and cogent insights. His laser sharp wit particularly spears electronic health records (‘no screens, no money’) and their contemporary uses in the USA that go way beyond health communication, and are actually huge billing and coding systems with the clinician as the data clerk. Busy doctors lack the skills or training to do either and are oft incentivised financially to over bill and up‐code. Some of the problem lists I encounter daily in the electronic health record I practice in are laughable in their complexity and useless in the care of patients. Both Cottler‐Casanova and colleagues (pages 660–4) and Hasegawa and colleagues (pages 665–7) point out how miscoding or lack of proper codes hampers progress around female genital mutilation complications and maternal mortality. If these electronic records and coding algorithms do patient care poorly, how much less should we expect when they are aggregated by researchers or health policy makers?


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Journal Article

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Journal Title

BJOG: An International Journal of Obstetrics & Gynaecology


Thorp, John M., Jr.