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February 5th, 2014
Electronic Medical Records, Eye Contact — and Dogs
- Long piece in the New York Review of Books — all doctors subscribe, of course — by Arnold (Bud) Relman, describing his experience as a 90-year-old who survives a fall. Riveting, moving, and typically curmudgeonly stuff from the ex-Editor-in-Chief of the New England Journal of Medicine. But this line deserves emphasis: “During the day I was visited on rounds by teams of physicians. They spent most of their time outside my room, studying and discussing the data on their mobile computers.“
- How do interns spend their time in the era of electronic medical records? Let’s look at the data — “Interns spent 12% of their time in direct patient care, 64% in indirect patient care, 15% in educational activities, and 9 % in miscellaneous activities. Computer use occupied 40% of interns’ time.“
- Or, for a more poetic description, read Abraham Verghese’s brilliant description of the “iPatient”: “On my first day as an attending physician in a new hospital, I found my house staff and students in the team room, a snug bunker filled with glowing monitors … the demands of charting in the electronic medical record (EMR), moving patients through the system, and respecting work-hour limits led residents to spend an astonishing amount of time in front of the monitor.”
- One of my colleagues in General Medicine, Jeff Linder (who parenthetically does some nice ID-related work too), found that the number one barrier to use of electronic medical records during an outpatient visit was loss of eye contact with patients — which does not surprise me a bit.
- The solution? Get a medical scribe to join you in the exam room so you can actually look at the patient while taking the history. This is the money quote from this wonderful New York Times piece: “For decades, physicians pinned their hopes on computers to help them manage the overwhelming demands of office visits. Instead, electronic health records have become a disease in need of a cure, as physicians do their best to diagnose and treat patients while continuously feeding the data-hungry computer.” FYI, after reading this piece, every single colleague of mine wants a scribe now.
- The hospital periodically receives patient surveys from these guys. The leading complaint, of course, is parking — this is Boston, after all. But in the Top Five Complaints is also something along the lines of, “That doctor seemed more interested in the computer than in me.”
- Department of Oversharing: I recently saw a doctor for an eye issue, and he was very competent and nice. He spent 90% of the visit (aside from the exam part) entering what I was telling him into his electronic medical record. The computer was situated far to his left, so he was facing away from me the entire time; I could have put on this hat, he never would have noticed.
OK, so I’m nearly done. Except to comment that we used to be able to take notes while facing our patients, and that this allowed a kind of organic eye contact that seems all but impossible in the electronic medical record era. Note that I won my 8th Grade Typing Competition (72 words/minute, thank you), so don’t blame inadequate keyboarding skills.
And since this started with a dog (dare you to click on the image above) and eye contact, I might as well say that they run rings around both cats and us electronic medical records-obsessed doctors when it comes to this skill.
Enjoy more dog magic in this wonderful documentary: