American College of Physicians: Internal Medicine — Doctors for Adults ®

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.


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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
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.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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