Monday, December 7, 2015
Lowering physician and patient satisfaction 1 click at a time
The use of information technology (IT) in health care holds so much promise, and potential yet to be realized. Ask any frontline physician and they will list electronic medical records (EMRs) as one of their biggest daily frustrations. A brilliant video by Zubin Damania, MD, also known as ZDoggMD, recently parodied the current situation and the pain felt by doctors on a daily basis. But it really isn't all about doctors. Patients too are on the receiving end.
Talk to many patients who interact with their physicians, especially in office settings, and they will cite their personal annoyance with the fact their doctor hardly looks them in the eye anymore. “Every few seconds the doctor just kept turning around and looking at their screen and typing away,” is a common complaint. Moreover, studies suggest that newly graduating physicians are spending an absolute minimum amount of time every day in direct patient care (as little as 10%). And I can well believe it. As I look around at lots of my hospital medicine colleagues, they are easily spending over 75 to 80% of their day staring at screens.
The proliferation of health care IT over the last decade has come about mainly due to the federal government's Meaningful Use program, and the fact that hospitals and clinics are incentivized financially to become fully computerized. And while I don't doubt that the program had some noble intentions, the way that systems have been rolled out across the country has been rushed and haphazard, with little thought put into the effects on the frontlines of medicine. Even away from physicians, seasoned nurses have been reduced to tears by the enormous data entry requirements now heaped upon them. Glance down any modern day hospital floor, and you will see nurses, who are the very heart of direct patient care, glued to their computer carts, eagerly pushing them around and barely having time to look up at their patients.
Make no mistake, we have witnessed something of a disaster happen in terms of what healthcare information technology has done to the doctor (and nurse)-patient relationship. The answer, however, is not to go back to the bad old days of pen and paper, mountains of charts, and illegible handwriting. The answer lies closer to home. The world of healthcare IT, administrators and entrepreneurs, who sit in ivory towers contemplating the “wonderful world of health innovation and computing solutions”, need to collectively do a much better job in understanding the realities of everyday medicine. The humanity, the compassion and the strong personal relationships. Which is exactly what they would want for themselves or their loved ones if they were sick. That's why we need to develop better systems that are designed to be seamless, efficient and quick to use. Above all else, there should be a recognition that the best health care IT of the future will be seen and not heard. In other words, take the physician and nurse back to where they belong: at the bedside.
We need a revolution in this arena of medicine, before the newer generation of physicians believe that being a doctor is a computer desk job with minimal human interaction. Until that happens, we are wasting the practical skills of hundreds of thousands, if not millions, of doctors and nurses. As for our patients, the new “type-and-click-bot doctor” is inadvertently lowering satisfaction and the health care experience 1 click at a time.
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.
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