Physician practices large and small are being herded into the panacea of the electronic health record. However, why do we tolerate a physician "texting" when he or she is examining a patient?
I applaud emerging regulations to outlaw "texting" while driving. From my 16 years as a county medical examiner, my files contain several photos of decedents behind the crashed wheel still clutching their smartphones. The device diverts attention from the task of driving. Why then, would we tolerate a physician "texting" when he or she is examining a patient?
WERE THE PATIENT AND SPECIALIST AT THE SAME APPOINTMENT?
Recently I was listening to my patient lament the "terrible" experience she had in the specialist's office. "They did not give me any time" was the complaint. "A total waste of time."
"Wait a minute," I said, springing to my colleague's defense. "You had a very complete evaluation-I have the five-page document right here."
"Read some of it to me," she said. As I began to read the document, very systematically organized beginning with the "chief complaint," followed by very detailed past history reviews, multiple system reviews, and a very thorough examination, the patient was aghast that her medical record appeared to be a complete work of fiction. "He didn't say or do any of that while I was there," she said. "He just sat there and typed." Welcome, ladies and gentlemen, to our new EHR system. Roll over Hippocrates and Osler.
TECHNOLOGY TO COMPLEMENT, NOT REPLACE, THE PERSONAL TOUCH
I like my technology. I typed this article on my Macbook. My patients are accustomed to seeing me pulling out either my Blackberry or Palm device to check an electronic reference for point-of-care information. But the system I like involves eye contact and conversation, the allotted time roughly split between history-taking and physical examination. Then comes more, the thinking about the complex case at night, researching literature, and reviewing labs and results as they come in. The typing, though, I delegate to our transcription department; they need jobs, too.
But alas, we continue to interview EHR representatives, because we know resistance is futile. The all-important "art" of medicine is being replaced by templates and checklists.
Perhaps the ideal system is out there. I haven't seen it yet. I will keep looking. At least for the short-term, the laptops stay in my office-and not in the exam room, as a distraction.
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