Blog | Friday, November 4, 2016

What I do every day to get away from my computer screen


I enjoy being a physician. I really enjoy being a physician. Although much of my blog is focused on areas where we need to improve health care, with a particular recent focus on the burdens of information technology (including this article on reaching a critical mass of dissatisfied physicians), that does not take away from the fact that I do really love my job as a doctor.

I've received a lot of supportive correspondence regarding my views on how electronic medical records have adversely affected the frontlines of medicine. It's not surprising really seeing as this is one of the top daily frustrations for any physician (or nurse) in the United States. I have been very grateful for these messages of support, but articles and agreement alone are not going to solve this problem. Many doctors have also asked me how I personally go about navigating the electronic medical records that we are currently stuck with (and in my travels, I've worked with nearly every single major vendor, and in my opinion every single one of them sucks). I wanted to share my own personal philosophy for dealing with them:
1. I became a doctor to care for patients. My greatest job satisfaction (and also quality and efficiency) comes when I'm interacting with patients. My goal every day is to therefore spend as much time with patients as possible, and minimize my time staring at the screen and typing and clicking on a keyboard and mouse. Have a constant awareness of how much time you are spending with your computer (because at a subconscious level, whether you realize it or not, every extra minute spent with your computer will dramatically increase your chances of job dissatisfaction and burnout).
2. When I've encountered any particular electronic medical record for the first time, I quickly work-out any short cuts that I can take to navigate their cumbersome and inefficient nature. There are always lots of them available. Spend the minimum necessary amount of time documenting what you need to get done. Also work out ways to minimize the number of clicks done to get to where you need to go.
3. For a quick task, such as putting an order in for Tylenol, avoid sitting down at the computer terminal. Do it standing up, on the go, so you can get back to where you should be: with your patients.
4. Keep talking to your patients face-to-face, sitting down and listening the good old-fashioned way. Try not to be distracted by the screen (it will greatly annoy your patients if you do this). Patients really appreciate talking properly like a human being. Two minutes doing this is worth 10 minutes of turning around every few seconds and typing and clicking boxes in front of your patients.
5. I am dismayed by the way that electronic medical records turn my patients' stories into reams of garbled data and incomprehensible mish-mash. Rather than use the computer “template”, I use free-text and my own template based on a comprehensive and proper SOAP format (subjective, objective, assessment, and plan). I particularly dislike the computerized physical exam “tick boxes”, and free type in my own examination findings. I simply refuse to let healthcare information technology turn the noble art of medicine and physical examination into a mindless tick-box exercise. Also be sure to thoroughly review laboratory results yourself instead of just relying on the computer to “import them” without a proper analysis with your own eyes.
6. I try to “batch” computer tasks together as much as possible, so that I can do them all at once, instead of having to keep going back and go through the same inefficient process every few minutes.
7. Give constant feedback to your hospital information technology department regarding ways to improve the system. It could be something as simple as a change in the menu order when options show up on the screen, or a change in user interface. Either way, if it takes 1, 2, 3, or even 10 emails and phone calls—be ruthless in making them listen to you.

I became a physician to communicate with patients, and this is also what the public perception is of a doctor. Unfortunately the world of health care IT, administrators, and regulators has turned being a doctor into data entry.

An interesting blog article came out recently saying that the general public would be shocked and saddened if they knew what the life of a doctor now looks like, thanks to electronic medical records. Now I'm not suggesting a return to paper charts and a couple of sentences documentation scrawled on a piece of paper, but there has to be a happy medium. There are many ways in which our current electronic medical record systems can and must improve, some of which I've listed in this article which appeared on MedPageToday. The use of scribes may also be a viable solution, as I wrote about in another article here.

It is a travesty what electronic medical records have done to our ancient and noble profession. The time that physicians (and nurses) are spending with them is unacceptable, and quite simply a national disgrace.

Every day on my way into work I make a conscious decision to do everything possible to be like picture number one. Like that good old-school physician we all know. No matter how much the current system tries to take me away from that, I will be that doctor. I will be that doctor.

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.