Blog | Monday, January 21, 2013

Unsigned notes

We're supposed to sign all our doctor's notes in the old system so they can be carried over to the brave new one. But even when all our notes are squared away, and even when the new system fixes the flaws of the old ("and adds some extra, just for you"), there will be the same disconnect between chart and patient.

The chart, especially electronic, is a linear sequence of notes. But the patient lives continuously and her problems get worse or better even when we are not in the room with her.

The patient's life is pockmarked with tragedies, illuminated with joy. But our chart entries are all moments pinned awkwardly to the screen with dissecting pins.

The patient is a person. We don't take them for all in all, but split them up into medical components: and then we wonder, when we read our own charts, why it's so hard to get a sense of the woman we have seen for years. And the patient wonders, when she sees those notes herself, why it doesn't sound like her at all.

There are attempts, like narrative medicine, to record the manifold experiences and emotions of the person who sits in front of us. But they are not what happens in the vast majority of doctors' offices, where we measure out someone's life and health in fifteen-minute increments and electronic boxes checked off just so.

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. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.