I was recently talking to a patient about having some extra help at home when she left the hospital with home nursing services. The elderly lady, highly intelligent and fiercely independent, politely declined with the reply: “No, I'm fine thanks Dr. Dhand—all they've done before is just come in with their computers, barely talk to me, enter a few things on their keyboards and then leave.”
This reply really struck a chord with me (as someone who has written extensively on all that we need to do to improve the use of information technology at the frontlines of medicine). We then engaged in a brief conversation about all the changes she's seen over the years and how medicine now seems so fragmented and impersonal. I finished with a strong feeling inside that I really couldn't blame her for declining additional “robotic” services, and that she was talking absolute sense about her experiences.
Her reply is typical of dozens, if not hundreds, of similar complaints I've heard over the years about how doctors (and nurses) are simply too pre-occupied with their keyboards and screens and barely look at a patient nowadays. This problem particularly affects the more generalist medical specialties—including primary care—which should be the cornerstone of all health care.
The last decade has seen the proliferation of information technology, mainly due to Meaningful Use and the government's incentives for the computerization of the healthcare system. Let me pause right here and say that I am far from advocating a return to the paper chart or the archaic days of yesteryear. Many of the aims and goals behind Meaningful Use are noble ones. We simply need to redesign the current systems so that they are fully optimized for frontline medicine, and design them to be as seamless and efficient as possible so that doctors and nurses can get back to where they belong: with their patients talking face to face. Likewise, doctors and nurses need additional training on how better to use the information technology so that it doesn't come in-between them and their patients.
A study published not so long ago in the Journal of General Medicine showed that medical interns now spend only around 10% of their day engaging in direct patient care in hospital and almost half their time with computers. That's a shocking statistic and an unfortunate imbalance. I'm sure if a comprehensive study was done on primary care doctors and how long they spend looking at actual patients versus their screens, the results may be even more disappointing. If it were expanded, the same study would probably also show that one of patients' biggest let-downs would be when their doctor keeps glancing in-between them and their screens. So if we are really serious about improving patient satisfaction and the healthcare experience, how can we let this situation go on?
I hope that in the not too distant future the world of frontline medicine, IT, and hospital administration, can all get together to solve this problem. I gave a presentation last year in Boston titled: “Healthcare IT: what the frontline of hospital medicine really needs”. The audience was a mixture of entrepreneurs, techies and clinicians. The biggest round of applause I got was from the clinicians when I opened with the provocative statement that healthcare IT has done more to destroy the doctor-patient relationship over the last 5 years than any other 1 single thing. I stand by that statement and hope that we can change things. Until that happens, we continue to massively let down our suffering patients.
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.