It sometimes seems like we’re losing control of medical care, not to the traditional culprits, those cookbook-generating government agencies, but to a new culprit, our own EMR’s, EMRs paid for with our own hard-earned dollars, lured as we were by promises of increased practice efficiency and cash handouts for “meaningful use,” EMR’s steadily and insidiously altering the way we practice medicine, first by helpfully writing our patient notes, notes which are increasingly imbued with extraneous data, becoming pathetically impossible to decipher and unhelpful in the clinical setting, then by adding laboratory ordering templates, making it simple to order a multitude of expensive, recurrent labs with a few simple keystrokes, leading to a blizzard of data impossible to comprehend except for those nifty little graphing tools provided, then by re-writing multiple prescriptions for us with one keystroke, prescriptions the patient may not need and have no intention of filling, an intention unknown to the us, spending as we do most of our time pecking away at the computer keyboard, searching for screens, selecting data points, and deleting those pesky alerts about allergies or potential contraindications, alerts which are habitually ignored as a consequence of information overload, all this instead of interacting with or even looking at the warm body in front of us which is commonly referred to as a patient, an unfortunate creature not made from silicon, but from carbon, a creature increasingly bewildered by the complexities and mysteries of the medical care system, but nevertheless increasingly inclined to complain about his unhappiness with his interactions with his physician when given the opportunity by way of exit surveys as he leaves the hospital. 1
This will not do. We cannot allow this new technology, challenging as it is to deal with and important as it is to the future of medicine, to interfere with our relationship with our patient who is depending on us and needing us to give him a personal touch of care and encouragement. While realizing that computers are here to stay, while struggling with the steep learning curve involved in dealing with then, we must daily seek to tame this beast to the service of our patients. Preoccupation with silicon-based issues (computer glitches and the like) must not lead to the neglect of the carbon based (i.e. patient) issues that are our primary reason for being. Here are some ideas:
DO: Write an assessment at the end of your note with your own hand, expressing your summary of what is going on with patient and what you intend to do about it. This will enable other attending physicians, now and in the future, to use your note to help with ongoing care that they provide.
DON’T: Write, under “assessment”: the words, “as above”
DO: Talk to and look at the patient periodically while you are dealing with the computer. Tell him what you are doing, and why.
DON’T: Ignore the patient for long periods while typing, leaving the patient disconnected with his doctor, free to make up his own mind about what you are doing, perhaps imagining that it has little or nothing to do with him.
As always, you, my carbon based readers, are welcome to add additional ideas by way of letters to the editor.
1 I’m compelled to point out that this rather long sentence is nonetheless intelligible because it is written by a human, not a computer. You won’t see computer-generated text in this publication while I live.