Friday, March 11, 2016
Medicine: Where have the stories gone?
I was at a dinner meeting for our hospital last week, and before everyone went in to sit at their tables and hear the evenings' speeches, there was some time for the usual networking over wine in the reception room. I got chatting to an established local primary care physician, a respected member of the hospital staff who has been in practice for over 30 years. He's quite a presence and a great clinician, someone who still finds himself coming into the hospital to work on various administrative duties. I expect every hospital in the country has characters like him wandering around.
We got chatting about all the changes that have occurred in medicine over the last few decades since he first graduated, and the conversation quickly turned to his dislike of the current information technology systems (the IT crowd unfortunately tend to live in a bubble of the “wonderful world of connectivity, big data, and cloud solutions”—but this conversation could have happened anywhere in America). During our discussion—as we commiserated about how physicians and nurses are glued to their computer screens nowadays, clicking boxes, and typing away furiously on their keyboards—he said something that really struck a chord. He said, “You know what, Suneel? The stories have really gone from medicine”.
What did he mean by this? He elaborated and we continued talking. In a nutshell what he meant was that in the past, every patient was a story. A unique person. A human being. This patient was well known to their personal physician, whom they usually had a good and strong relationship with. Even when documenting information in a hospital, when a physician saw a patient (regardless of whether that physician already knew the patient), there would be a story that would appear on the computer or in the chart in the form of a transcribed letter. This was either a “history and physical” report or a “discharge summary.” It would take the form of a narrative, in proper English with logical paragraphs and sentence construction, and tell you all about what was wrong with the patient, their individual history, and the diagnosis and treatment plan.
Unfortunately, what has occurred over the last few years has been quite the opposite. If you look at these narratives as they appear in the world of healthcare IT, they have developed into reams of computer gabble. A patient's story is now a series of tick boxes, random meaningless data, and ill-thought-out information flow—difficult to read and decipher. Glance at a print out of this, and they are no better than a typical handout you would get from a car dealership after your car has been serviced. Far inferior to the good old-fashioned transcribed letters that would tell you what happened to a patient in a more proper format. Worse still, many office-based interactions with physicians are now reduced to screen staring and mouse clicking, as the patient's story gets told in a row of tick boxes.
While nobody wants to go back to the days of paper charts, we must do better than this. Doctors are intelligent people, and the computer output that results from our most important interactions needs to return to a well-designed and more logical narrative.
The physician that I had this conversation with likely only has a few years left till retirement. I'm glad many of his generation are still here to give us their perspective of the changes we've seen occur in the practice of medicine. As for his patients, many of whom I've taken care of, they are still very much in awe of a doctor who knows how it's done. A doctor who listens to them, talks to them face-to-face, and keeps his clinical reasoning skills. And one who ultimately understands that health care is all about real people who are all their own stories.
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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