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Maintaining a doctor-patient connection


Much has been written about the financial and practical use of electronic health records, but what impact is it having on the relationship with our patients?

My mind momentarily drifted back to those first few months when I learned to use an EHR-not particularly fond memories.

Flash forward to the current office visit: Although a brief period of sustained eye contact occurred during a conversation about how it is my child's job to try one new food daily (today we are attempting beets at our house), the most substantial interaction of the visit involved the midlevel and her keyboard. I don't fault her for that; I've been there. But seeing it now from the other side allows me to reflect on how my patients must have felt during that awkward time.

Much has been written about the financial and practical uses of, and pros and cons of using, an EHR, but what impact is it having on the relationship with our patients? Like layers on a cake, the invention and implementation of the EHR may be compounding upon one of the primary complaints that patients have had with physicians since the Hippocratic oath-we don't listen to them.

This concept continues to be a hot topic in the media and lay press. On television, I've witnessed a daytime talk show-a full hour episode-entirely devoted to audience members telling stories about how their doctors don't listen. The program was painful to see, but yet, like a car accident, I watched, mesmerized and offended, wanting to defend our profession.

At the grocery checkout, we regularly see front-page magazine one-liners claiming, "How to get your doctor to listen to you" and "Making the most of your doctor's visit," right next to "New ways to blast belly fat." Now that's saying something.

Maybe it's a valid patient claim. If a tree falls in the forest and no one is around to hear, does it make a noise? If a patient's lips are moving and the doctor is too busy at the computer, is the patient actually being heard?

Okay, we're obviously listening, but are we actually attending to what the patient is saying? If our patients were complaining about our listening skills before, chances are the computer in front of us is not helping the situation. By using an EHR, we anticipate everyone will benefit in the long run, but it certainly does not mean immediate gratification for the patient or the physician.

If I recall my statistics from medical school correctly, most physicians will interrupt the patient within the first 15 seconds of hearing the chief complaint. I would be curious to know if those numbers have changed in offices with an EHR. Have the times improved, are they worse, or are we just so focused on jamming information into our laptops that we are listening even less? From personal experience, I would say that my time before interruption actually improved-but only because I was too busy trying to figure out which template of the EHR I was going to use or if I should be free-texting a complicated complaint.

With this estimated interruption time, along with the "improved technologies" of the EHR, it's no wonder patients think we don't listen!

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health