Tuesday, February 22, 2011
I like to read the doctor blogs. It's interesting getting perspective from behind the white coat. Hearing their struggles managing patients, running a business, dealing with insurance companies and of course, with illness and death has been useful to me as a patient. Well-written blogs can give us an idea about the problems facing the people who, by virtue of our disease, have become a powerful force in our lives.
One topic that pops up regularly on the blogs is the use of Electronic Medical Records, or EMR. Apparently, doctors are a bit behind the curve in managing patient health electronically. It stands to reason that having patient records online, accessible to other doctors, insurance companies and pharmacies would streamline care. I've read notes on my charts that are absolutely incomprehensible; once I even had a nurse hand me a piece of paper written by one of my doctors and asking me what it said. I'm pretty good at reading bad handwriting, but I had no idea, and it was about me and what was supposed to happen to me. That can't be good for a patient.
On the other side of the coin, different software companies make different solutions, and they don't all interface and talk to each other, so the dream of every one of your doctors being able to see another's notes is just that - a dream. There are privacy concerns when anything is done electronically, and of course, there are the typical user issues that happen anytime a new system is implemented. There is fear that the insurance companies will misuse the information and create more work for doctors' offices, or use something said in a note to deny a reimbursement. And, speaking as a former IT person - people just plain hate new software and often resist.
My oncologist's office implemented a new EMR system when I was in the middle of chemo In fact, they did training on the system during one of my long infusion days, right in front of my barcalounger, so I got to see the entire thing in action. Once the nurses learned the system, once they stopped cursing, I saw no difference in the care I got from them.
Not quite so with the doctor. My experience with him changed dramatically.
Before EMR: I would go to a exam room and sit on the chair, flip through a magazine or play Angry Birds on my iPhone and wait. Dr. would walk in, make eye-contact, and ask me how I was doing, or more likely, tell me how I looked to him. Then he'd sit down and face me, my chart on his lap. I would put away my phone and describe any concerns I had while I admired the oddball tie he was wearing that day, and he would answer while actually looking at me, occasionally glancing down to jot notes. There was a human connection there, at least as much as you will get with a professional physician whose specialty is people dying of cancer. We had a conversation. He'd ask a question and my response would bring up another question - or I'd remember a concern and go from there. We looked at each other. He was in control, but there was give and take. I'd leave the office feeling like my concerns had been addressed and my needs as a patient met.
After EMR: I go into the exam room and sit on a chair, play Angry Birds on my iPhone and wait. He walks in, makes eye-contact, ask me how I'm doing, and then turns to sit in front of the computer - with his back to me. My doctor, with his penchant for humorous ties, could be wearing a dead pig around his neck for all I know. I hear the mouse "click click click click" then he asks a question. I answer and then "click click click.... type type type type." Is he writing down what I said, I wonder? What is all that typing about when I just said I am taking my medicine regularly? Since I don't want to interrupt his train of thought while he is typing and clicking through various screens, I go back to playing Angry Birds. When he's done with what he's doing, he asks another question. I answer, and the whole thing repeats. Because each question/answer/type session takes so long, I continue to play my game while he works. This goes on for some minutes, and any human interaction or spontaneity is gone. It's a very stilted experience. I'm playing a game and he's deep in his computer.
Kind of like my family after dinner.
Because I saw him before EMR was implemented, because at that time I learned he's caring and competent and responsive to his patients, I don't feel slighted or that he's displaying a lack of interest. I don't think he particularly likes this system, in fact. I feel comfortable enough so that if I did have a great concern, I would express it even with his back turned. However, had this been my first exposure to him - had his back been turned to me during the early days of my cancer diagnosis, when I was facing the unknown and a bit scared, I might very well have turned my back as well - right out the door to another physician.
I understand the need for documentation, and am a big fan of technology. I was rooting for Watson, not Jennings. I also understand that many exam rooms are not set up so that a doctor can face a computer and a patient at the same time, which is the case with my doctor. I am guessing that many doctors are not experts at typing and it takes a while to input their notes, time which leaves a patient twiddling their fingers, which is also the case with my doctor. As a former IT professional, I can't imagine this particular system is well-designed, considering that it takes a dozen clicks to get anywhere but I have not (yet) snooped.
However, these are things that need to be worked out before fully implementing an EMR system, at least for any doctor who cares about making a human connection with a patient. There are tablets, iPads, laptops. There has to be a way to return to a bedside manner method of doctoring while still entering the digital age.
So much of being a good doctor, from a patient's perspective, is not only medical knowledge, which (rightly or wrongly) we typically take for granted, but also the ability to relate to us, to look at us and see if our truths are being expressed. Trust is essential - after all, the physician is about to cut us open, amputate a body part, radiate us, poison us with chemicals, tell us if we are going to live or die. We need to know that this doctor is a person who will treat us with dignity, who will do the best professional job for us he is capable of. We need to know he takes our concerns and fears seriously. We want him to want us to live.
It's very hard to gain that kind of information and learn to trust somebody with our well-being and our lives when all we see and hear is the back of a white coat and the click of a mouse.
EMR may be the future of medical management, but it hopefully won't come at the expense of a true doctor/patient relationship, which we patients really do need. While I admit I was rooting for Watson to win Jeopardy, the truth of the matter is, I'd much rather have Ken Jennings as my doctor.
Posted by Ann aka ButDoctorIHatePink at 2:42 PM