The AP (3/30) reports, “As the United States moves to paperless medicine, doctors are grappling with an awkward challenge: How do they tap the promise of computers, smartphones and iPads in the exam room without losing the human connection with their patients?” Georgetown University’s “medical school is developing one of a growing number of programs to train new doctors in that balancing act, this one using actors as patients to point out the problems ahead of time.” Meanwhile, “at Stanford University this summer, medical students will bring a school-issued iPad along as they begin their bedside training – amid cautions not to get so lost in all the on-screen information that they pay too little attention to the patient.”
Blogfinger Medical Commentary, by Paul Goldfinger, MD, FACC (actually, my degrees are 98.6)
Older doctors complain that time-proven methods in medicine are falling by the wayside as more and more technology intrudes into the interaction of doctors with their patients. Taking a good history is one such method—invaluable in making diagnoses. There is an old axiom: “Listen to the patient; he is telling you the diagnosis.” I have seen skillful clinicians unravel difficult cases by following that advice, but younger doctors often take short cuts due to time constraints and due to computer distractions.
In the recent past I went to a local ER. A physician assistant came into the room to take a history, but she turned her back on me so that she could make entries into her computer. She asked questions without looking at me, and, in the end, she got the diagnosis wrong.
A physician friend told me that he found it awkward to use a computer while he was interacting with a patient. He did say that new devices are coming in with stands that allow the doctor to look at the patient while making entries. Although the promise of electronic medical records is significant, the art of medicine should not be lost in the process.
Aside from the distraction of computers, I think that it is regressive and potentially harmful for doctors to be entering information into a computer while conducting an office or hospital visit. It wastes time and doesn’t allow for detailed and nuanced expression of the physician’s analysis.
In my own practice, I scribbled reminder words on a sticky-note in the patient’s chart and handed each patient a handwritten check list reminding them of the salient instructions and facts that they needed to have when they walked out of our office.
After the visit was over, I went back to my consultation room, alone, and dictated a detailed note which would be typed later and inserted into the chart. It was expensive to pay three transcriptionists, but it was well worth it. Maybe voice recognition software will solve the problems inherent in data entry by the doctor.
Meanwhile, during the transition to computerized medical records, while everyone gets it right, and that will take quite a while, there will be a stage where errors occur. Be careful and watch out for yourself as you navigate an imperfect medical world.
As a NJ EMT, we have been using electronic charts to document care on panasonic toughbooks for 2 years. Its easier and more descriptive then the old paper charts.
Its funny you mention the Merck manual, as I carry that in my pocket, as an app on my phone of course along with Harrisons Practice. I also use Epocrates to look up medicines I’m not familiar with, seems like there is a new one every day.
More likely he’ll be passing the wand into an orifice and then doing medical magic with some new technology.
Of course doctors need reference resources in the office. It used to be called a book shelf. Now it is the Internet. As a doctor in training, we all carried the Merck Manual or the Manual of Medical Therapeutics around in our lab coat pockets. They say that doctors learn the equivalent of two languages in medical school, but sometimes you still have to rummage through your pockets to get an answer. I think it’s better for a physician to step out of the room if he has to look something up. It’s a matter of—as they say these days in politics– optics.
I have seen two examples of super-specialists who take care of rare conditions who belong to an internet network of similar super-specialists from around the world. When they get a rare case of, for example, adult cystinuria, an extremely unusual genetic disorder (one in 10,000 overall; mostly in children—exceedingly rare in adults) they post it on the network and they compare notes with a small fraternity of docs who see such cases. If you have this condition in OG, your doc may discuss your case with a physician in Singapore. It is a remarkable new use of the internet in medicine, and I have personally seen it used twice: once at NYU Medical Center and once in Ocean Township, New Jersey. So if you are a doctor of that sort, please stay in the room and show your patient something amazing.
In 2010, the CDC reported that about 41% of US physicians were using partial or fully functional EMR’s (electronic medical records) in their offices. The numbers are growing, but that doesn’t mean that all of them had systems that worked smoothly and actually reduced medical errors nationwide. The quality aspects of their use are anticipated, but the jury is still out on this (and speaking of juries, it remains to be seen if EMR’s result in reduced rates of malpractice cases; we already have seen that they might not save any money.) PG
Here’s an interesting article from the NY Times that may surprise those of you who are interested in this topic:
http://www.nytimes.com/2012/03/06/business/digital-records-may-not-cut-health-costs-study-cautions.html
My rheumatologist’s practice uses laptops for patient consultations and medical records storage, and it has worked out well for them. In each exam room, there is a laminated list of “computer principles” for the medical assistants, nurse practitioners, and physicians to follow, which include facing the patient while inputting information. The computerized medical records system has been a godsend in terms of compiling notes and orders from all six of their offices, being able to store blood test results and medical imaging in one location, and keeping track of the many and varied medications a patient with autoimmune arthritis-related illness may be taking. Best of all, my physician and his colleagues can access all their patients’ records from anywhere with Internet access, so if a problem crops up on a weekend, your physician can make a decision based on your specific medical information.
My doctor sometimes looks up information on webmd.com right in front of me. Another doctor was reading the instructions that came with stitch removal kit right in front of me just prior to removing stitches. Is either inappropriate ?
Doctors are human like the rest of us and can’t possibly know everything. So maybe means to immediate info on the spot thru modern technology is a good thing. Perhaps, in the future, doctoring will be like it was on the TV show Star Trek where the good doctor simply passed a wand over you to determine what was wrong with you.