Letters: Readers comment on Medical Economics stories

November 5, 2010

Letter addresses how the value of face-to-face contact with patients may be diminished with use of electronic health records.

Human interaction over EHRs

What has happened to the heart and soul of family medicine? In the 1980s, we were taught to listen and engage with patients. The history was the key to unlock the depth of the patient's concern, and making eye contact was important to grasp what the patient was really trying to convey. All of these social skills allowed the family physician to diagnose more easily and effectively.

Fast forward to 2010, and as family physicians we are constantly bombarded by the need to acquire electronic health records (EHRs) because it will allow us to treat our patients more efficiently and to see more patients every day.

I read all the journals and current medical literature with physician feedback about EHRs (including "Another perspective on electronic health records," [by Brian W. Meeker, DO], May 7 issue). I have heard and read horror stories of physicians facing away from the patient while typing at their new high-tech keyboards so they can supposedly be better doctors.

As a family physician (25 years of active practice), I worry about losing the special interaction we have with our patients and whether the EHR "monster" will take this away.

Before I examine patients, I always want to know what they have been up to, what vacations they have taken, what special interests and hobbies they are now pursuing. Obviously, this has to be a relatively short conversation because our time is so limited, but this interaction is what makes family medicine so special.

I truly enjoy talking to a particular patient, an 86-year-old former state jousting champion. I have "traveled" much of the world through the eyes of my young and elderly patients. I share in the excitement of every new grandchild and love to hear about the career goals of my younger patients.

It is now time to see the next patient. Before I enter the exam room with our nurse practitioner, the patient's initial complaint in the computerized schedule is supposed to be a run-of-the-mill sinus infection.

I ask the patient how he is doing. You can hear a pin drop in the room, and all eyes are moist when he says, with a slightly stuttering voice, that he is doing okay with his 2 young children while his wife is battling metastatic breast cancer to the brain.

These are the times when our training really kicks in, and we try to console patients to help guide them through such incredible hardships. The "easy" sinus infection takes a back seat to this patient's current grieving situation. This is a history I do not want to take while typing on a keyboard. It seems too cold and insensitive to me.

Typed words can never convey the emotions our patients are really feeling in that small 8 by 10 exam room.

Human interaction with real conversation is what drives all of us in this specialty, and we need to always remember how special this bond is between our patients and ourselves.

I am confident family medicine can continue to thrive and grow as long as we remember our true roots in this wonderful specialty.

DAVID MCCLURE, MD
Bel Air, Maryland

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