Daniel Kaplan, MD, has been a hospitalist since before the term was invented. In this week’s faculty spotlight, the self-described “purebred clinician” talks about perioperative medicine, the evolution of EHRs and how birding (sometimes also known as bird-watching) acts as training for practicing medicine.
How long have you been at Duke? How long have you been at the division?
I will have been at Duke and the division for 10 years this March.
Where do you work? What does a typical day for you look like?
I’ve been a hospitalist since 1993, since before the term was coined, and a purebred clinician. So my work is all on the general medicine wards. We all do a mix of attending on the teaching services and caring for patients on our own. I particularly enjoy working with the housestaff, where I try to model clinical skills, less reliance on technology, and economy and clarity of both thought and documentation. I needed clarity long before those buttons appeared.
One of your areas of interest is perioperative medicine, or providing care to patients as they consider, prepare for and recover from surgery. What sort of needs to patients have throughout this process? What do you enjoy most about this area?
It’s not as exciting as figuring out why someone is sick, but there is some interesting physiology we can sometimes help navigate. It’s also an area with many opportunities for more rational, cost conscious care – where evidence is mounting that less is more – examples include preoperative cardiac testing for patients without symptoms of CAD, and transfusion thresholds.
What’s the biggest change in your daily practice since you came to Duke?
Undoubtedly the evolution of the electronic health record. I’m old enough to remember poring through volumes of paper charts, often falling apart or missing volumes, and I wouldn’t want to go back there. But the EHR is only as good as the quality of the information we input, preserving the bad along with the good, so accuracy and currency are more important than ever. I worry, too, about lack of mindful engagement with auto-populated data, cutting and pasting without processing, and about losing the nuances of the narrative to rigid programmed phrases.
You’ve done some writing on the interface of clinical reasoning and documentation. Can you tell me more about this writing? Does this subject entail at all with some of the problems you’ve seen with EHRs?
I’ve written a couple of thought pieces on the subject. I’ve been troubled by a lack of diagnostic synthesis by medical trainees – that is, failing to get past symptoms and organ systems to clear understanding of what the patient’s problems are. A great value of the EHR is that it insists on creation of a problem list, though unfortunately it still allows very vague and redundant entries. Insisting that it’s accurate, precise, and succinct is still up to us humans.
What passions or hobbies do you have outside of the division?
Birding (non-practitioners know it as birdwatching) – It’s wonderful training, all about problem solving through attention to detail and pattern recognition. Puzzles fly past us and we try to name them before they get away. Like medicine without the stress. No one gets hurt if you make a mistake.
