Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
Joel Diamond 1/24/09
Patient Perspectives on New Technology
I remember a few years ago when one of my mentors in Family Medicine told me that the use of computers during patient encounters would destroy effective communication. "Doctors will pay more attention to the screen than their patients."
As we strolled down the hospital hallway, I asked him to watch several doctors who were talking to patients with their noses buried in the paper chart. "What do you call that?" I asked. "Charting," he sheepishly responded. I suggested that it was just bad doctoring.
It reminded me of watching bad surgeons wielding a laser during my training — pure carnage. So while good technology has the potential to turn surgeons into butchers, so can it reduce bedside manner to the lowest form of social ineptitude. Pardon the mixed metaphor, but new technology is always a blade that cuts both ways.
Here’s a different take on the same subject. When I first installed my EMR many years ago, I, too, struggled at times while navigating my way through new templates and would frequently apologize to patients when I forgot to maintain eye contact. Most patients would tell me not to worry — they were delighted that I had made a commitment to improving the quality of their care and were tolerant and appreciative of the obvious struggle. I soon discovered, however, that distraction can have its advantages.
We all have been there — the lovable-but-boring patient who comes in month after month with no real problems other than a need to talk. It’s uncanny how they manage to schedule their visits on the busiest, most stressful days.
During one such encounter, I started to wonder if I could perhaps multitask a bit. My new EMR had electronic messaging. Would it be possible to take care of a few refills while my patient was droning on about the amazing coincidence of her urinary incontinence treatment and her cat’s UTI?
After completing the fifth message in my inbox, I couldn’t understand why the EMR vendors didn’t use this as the main selling feature. Talk about work flow … this was awesome! I confess to only slight guilt as I encouraged my patient to tell me more about her cat’s medical issues. I was on a roll here — maybe I could review some labs as well.
My joy ended, though, when my patient cleared her throat. It seemed like I had been caught. "Dr. Diamond", she started, "I know that I must bore you month after month, and I realize that you are a busy man with more important things to do. But you always listen to me and never act like you’re rushed, and you make me feel like someone cares about me."
I winced as I anticipated what I thought would come next. "You know," she said, "now that you have that fancy new computer, you seem to type a lot while I have been speaking." Imagine my shock when she said appreciatively, "I want to thank you … for taking all those detailed notes on everything that I’ve been telling you!"
This seems to me to be the perfect example of technology being a double-edged sword. We have so many tasks to complete and are often conflicted about the time we would like to spend with our patients. Work flow can mean many things. Let’s just remember that maximizing both compassion and quality during the patient encounter can be an enormous incentive to doctors if carefully coupled with return on investment.
Joel Diamond, MD is chief medical officer at dbMotion, adjunct associate professor at the Department of Biomedical Informatics at the University of Pittsburgh Medical Center, and a practicing physician at UPMC.
Excellent point Joel! Too often this argument is made by doctors who don’t remember what it was like when they had to learn how to write on paper and listen at the same time… there is no doubt some lerning curve here, but eventually – the pros will outweight the cons in the right hands.
I still remember my first “awkward” experience during the first month of our EMR implementation. Mrs. C was an energetic and feisty 75yo Italian woman who could talk, and she liked my attention. So when I was busy typing into the EMR as she was talking, she stopped and did say “stop staring so much at that computer and start looking at me”. I stopped, and looked at her and said – “I promise I’m paying attention, but I do need to look at the computer to get in all your information. And remember, as our system is integrated throughout our group and the hospital- if you ever see another physician in our group or have to go into the hospital- they will be able to see all your allergies and meds and notes – so it really is a good thing for your health.” She thought a moment, and said “OK, you better pay good attention to that computer then!”. She “got it” and I knew if she could… then all my other patients would be a piece of cake. Seven years later, I know my patients would be upset if they saw a doctor writing their notes or prescriptions on a piece of paper – they all get it.
Dr. Diamond believes he has figured out how to turn a negative into a positive. Unfortunately most patients do not feel the same way his patient does, as witnessed by the findings of the New England Journal of Medicine and the National Research Council, to mention only two. These studies found that patients do prefer eye contact and human interaction and resent their physician’s misdirected focus on a piece of hardware. The underlying structure of traditional EMRs makes it impossible to overcome this challenge, and patients will continue to feel ignored until physicians adopt alternative technologies that accomplish the goals they seek while maintaining the valued patient-physician relationship.