Blog | Tuesday, August 25, 2015

Not letting a computer come between me and my patients

Ask any frontline physician at the moment what one of their biggest daily frustrations is and you will probably hear a very similar thing whether you are talking to a primary care, emergency room, or hospital physician. The thing that most takes them away from patients and makes them forget the reasons why they went to medical school in the first place, is the need to now spend most of their day staring at a screen and performing data gathering and “type and click” tasks.

I personally am yet to hear of any doctor who is happy with their electronic medical record, and I've worked in many different hospitals up and down the East Coast (that use a number of different vendors). Hate may be too strong a word, but then again maybe it isn't according to some things I've heard physicians say about the computer systems that have been foisted upon them! If we take a step back to when this process all got accelerated, it's largely been a result of the federal government's Meaningful Use program. And while I don't doubt that the program had some very noble intentions, and neither would I ever say that information technology in healthcare is all bad (far from it, a lot of it is quite brilliant in terms of being able to quickly search records), the problem has been in the implementation and the IT solutions that are available currently not being properly reconciled with frontline clinical workflow.

A study in the Journal of General Internal Medicine not so long ago showed that medical interns now spend only 12% of their whole day in direct patient care. That's a shocking statistic if it's the future of medicine.

The fact that doctors are having to spend so much of their time in front of computers, does an absolute disservice to the patients we serve. I've lost count of the complaints I've heard from patients regarding this. “My doctor never even looks at me.” “My doctor just keeps turning around to tick boxes on a computer when I'm with him.”

Because of this, and my absolute resolve to not become like that, I've developed some rules for how I interact with patients in the hospital. This includes never taking a portable computer or attempting to document anything electronically when I'm in a patient room. I always sit down and make eye contact with my patients and if I need to take notes, I do it the good old-fashioned way of writing things down. There's something about entering information on a computer as people talk to you that makes you seem less engaged. We've all experienced this before whether we are at a hotel, airline counter, car dealership, or just about any service situation. When you are being asked for information, it just seems a lot more attentive when someone is sitting right in front of you writing things down as you speak and maintaining eye contact. Computers just don't make the cut. I'm happy to do all the required electronic documentation after I see the patient, but won't let it distract me when I'm with them.

Secondly, I keep close watch on how much time I'm spending with patients during the day. I do everything possible to tip the balance towards direct patient care, including keeping electronic documentation to the minimum required for a good comprehensive patient note and avoiding sitting down at a computer if I'm performing an “on-the-go task” such as placing an order.

Thirdly, every computer system has its own unique quirks and characteristics. As anyone gets used to the system, there are often shortcuts and quicker ways of doing things that become apparent with time. Use these to your advantage. The people who design these systems are not clinically minded (and indeed, many of them are fortunately too young to have barely set foot in a hospital). Neither do they fully understand the world of medicine. It's our fault too perhaps for not insisting on intense clinical feedback when systems are designed, but any feedback you can give or ways of improving the system—be sure to spread the word.

As great as computers and information technology are, medicine is about people, and always will be. It is a uniquely personal and emotional arena. There are certain universal truths when it comes to humanity, and Hippocrates had it right over 2 millennia ago when he offered a pearl of wisdom for everyone in health care: “Cure sometimes, treat often, comfort always.” That's the human side of medicine that no computer can ever touch. For me that face-to-face time with my patients is part of the sacred doctor-patient interaction, and I will not allow any computer to come between us.

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.