Don’t computerize my doctor

electronic_medical_recordsOne of the first savings/efficiencies mentioned in the discussion of health care costs was greater implementation of electronic record keeping.

Makes sense, right? After all, this is the computer age, the age of the Internet. It seems logical to make our medical records electronic, quickly accessible by any doctor or health care worker who needs them in order to give us the best possible health care. All your details from all your different doctors and labs and hospitals — right there together in your electronic file.

Sounds good. All those entities should be able to see what all the other entities have and are doing for you — comparing, combining, cross-checking and aligning all your exams, lab results, and treatments. That synergy is definitely going to work in your favor.

To me the biggest weakness of electronic records, and the biggest concern, is the original input. My doctor walks into the examination room carrying a laptop computer, which she sets on a counter over by the wall. Concentrating on the computer, she asks me questions and taps on the screen to enter my answers — or the best approximations thereof — provided on the screen. Sometimes she pauses and mulls over the options before tapping.

‘Scuse me, doctor, but I’m sitting over here. I’m a real person, not a computer entry. Does that program you’re using take into account my anxiety about the situation? How ’bout the fact that I look more harried than usual today, more unkempt? What if my answer isn’t listed there on your screen? Do you just tap on something else, something that’s “close enough” but not exactly what I said?

If you were over there typing like crazy, entering your own notes about what I’m saying, I’d feel a lot better. But to have me sitting here pouring out the details of my particular problem while you sit there deciding whether option A, B, or C most closely matches what I said … I’ve gotta tell ya, doc, that does NOT inspire confidence. I don’t want my health care and my chart dependent on whether some programmer somewhere remembered to put my particular symptom on your list of options.

One example of how this can result an inaccurate medical record: a patient mentions she rarely goes out, is shy, and mostly stays home. That’s rather vague, but the diligent nurse wants to note it among the symptoms and conditions she’s itemizing, so she clicks on the closest approximation offered by her computer. Several years later, when the patient sees a printout of her medical record, she notices she’s been diagnosed as agoraphobic. Wrong! Agoraphobia is a serious, debilitating, medically diagnosed phobia. The patient is at most is a shy loner, possibly depressed, and maybe just plain lazy.

Another example: a patient is treated for an obscure problem in her right hip. She notices later on a printout that her chart says left hip. (Want to bet how small and close together the options for left and right were on the computer screen?) Not significant, unless the problem recurs and a different, less savvy doctor is trying to figure out what’s wrong with the right hip.

Patients may have no reason to keep a copy of their medical records at home, but they are legally entitled to a copy and it’s a good idea to get one occasionally, just to make sure everything in it is correct. There may be a small fee involved and it can take six or eight weeks to get it, but you are legally entitled to a copy. Don’t let anyone tell you otherwise.

Medical care is both a science and an art. It’s a very human, very personal one-on-one relationship between patient and doctor. And at some point, for all of us, it will be a matter of life and death. Good medical care is critically dependent on the doctor’s observing and noting nuances, subtleties, and changes in the patient and taking these into account. If the doctor is concentrating on a computer screen, she’s not focusing her full attention on her patient. If the information she enters on that patient’s chart is limited to or constrained by a list of pre-selected options, much of what makes that patient unique is probably being disregarded and could affect the care she receives.

physician-patientThere is wonderful potential in electronic medical records. But there is also the temptation to take shortcuts, to overlook or fail to note important details about the patient’s condition, and in general to depersonalize the doctor-patient relationship.

Leave the computers to the nurses. Let them enter BP, temp, respiration, current prescriptions — all those specifics that computers are so good at crunching. Equip the doctor with an inquisitive, open mind; a warm smile; a confident manner; a gentle touch; a willingness to listen; a measure of humility; and a caring heart.

Just because something can be computerized doesn’t mean it should be. We get little enough actual time with our doctors as it is. There’s no place for a computer when a patient needs a doctor’s full attention, concern, and reassurance.

4 comments

  1. I have to agree with you on this as well as the fact that it is easier to steal electronic records than hardcopy records. I understand the desire for efficiency, saving paper, space and all that but aside from the coldness of the form, especially for a doctor in an exam room with a patient – forms as we well know, never really cover everything – and are only as good as the people who created them.

    Absolutely, do get copies of your medical records and keep them in a safe or someplace that will keep them protected – electronic records are also more easily deleted and lost forever.

    Annie
    _________
    Yep, I’ve got my copies. And the examples I cited were in my records. I’ve since changed doctors.

    I still don’t like the computer in the exam room. My family practice doc does that, and it’s very cold. My ophthalmologist, on the other hand, keeps paper files and sits there chatting with me while jotting notes on my chart. It seems very warm and personal. The difference in atmosphere is amazing, yet I’ll bet neither doctor thinks about it or considers the impression on patients.

  2. I’ve written about barcode point-of-care technology, such as bedside scanning when a nurse comes to administer medications in the hospital, and it’s a hot thing in pharmacy right now. The trouble is that many systems are proprietary to whatever hospitals or hospital systems use them, and there are many, shall we say, b.s. options for overriding and bypassing the required steps, anyway. There’s a lot to iron out with that.
    ___________
    If I were to land in the hospital (which is inevitable sooner or later), I’d make sure I had somebody (friend or family) with me at all times, questioning and double-checking every move made by doctors, nurses, staff, etc. (And someone to smuggle in palatable food, if necessary.) Good intentions don’t make up for bad mistakes, and computers are only as infallible as the humans who program and use them.

  3. I do see your point, however, about 4 years ago, my doc brought his laptop into the exam room and was still extremely professional. He was typing away but what if he’d just been jotting down notes in his (possibly) sloppy handwriting? It just seemed more clear cut to me. Also, time saving. I’m a typer- that’s something I love to do and much prefer it over handwriting any day, but that’s just me. Imagine he brings it out to the nurses station and prints out his copy- hands it over to the nurse and they can actually read what he wrote! I’d have to see the actual physician computer program to know if I thought it was bad or not.

    Getting a copy of your medical records is an excellent idea, just to be sure everything is correct.
    _________
    Great point about the handwriting. Doctors’ handwriting is infamous. I like that my doctor sends my prescriptions directly from her keyboard to my pharmacy; illegible handwriting on prescriptions is notorious for causing mistakes.

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