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.