Why don't you like electronic health records?

I am a creative thinker, and I do my best work when I am thinking "outside of the box".  The quality of my work would be seriously degraded if I could only express myself within the confines of a mandatory script written by a computer programmer with a tiny fraction of my medical knowledge.  My speech recognition dictation system is a better tool for communicating than any electronic record system on the market when it comes to my explaining my thoughts to other physicians.   It permits me to describe exactly what my patients tell me, what I observe, what I am thinking, and why I think the person has one thing rather than another.  I can explain why I am utilizing one diagnostic or treatment strategy rather than another for that individual patient.  I am a consultant in digestive diseases, and many of the physicians who send me patients tell me that my reports are educational as well as informative.  EHR's are rigid, require the physician to make choices  which are preselected by the computer programmer when the choices may only be approximations of the real answer.  They use the "best fit" approach even if the best fit is not necessarily accurate.  They do not permit the doctor to do much "free form writing".   They "pigeon hole" patients, and the description of every patient with the same diagnostic code looks the same when people with the same problem can be quite different.  The numerical code for erosive gastritis does not distinguish the patient with one tiny sore in the stomach from the person with several hundred erosions.  The numerical code for diverticulosis does not distinguish the patient with 1 tiny sack in the sigmoid colon from the patient who has a tangled, scarred matted mess with adhesions.

Furthermore, the real work a physician performs is focused, flexible, and cerebral.  In my situation, it often is important for me to explain to a patient why something is so or why one course of action is better than another.  That is a more meaningful use of my time and the patient's time; focused question and answer conversation is much more useful to the patient than requiring me to run mindlessly through a list of questions about whether a person has any problem with their eyes, ears, nose, throat, sense of taste, or a myriad of other senseless queries that are irrelevant to the patient's gastrointestinal problem of the day.  What I do best cannot be measured in the current EHR format and is not given credence as work in the new definition of physician work.  It is more important for the physician to ask the right questions and to pursue answers in focused detail rather than asking a large number of irrelevant questions from an EHR list.  EHR's reward the quantity of information gathered rather than the quality of information -- even if the majority of the information gathered is irrelevant.