In The Digital Pandemic, Reestablishing Face-to-Face Contact in the Electronic Age, I reported on my visit to a hospital for some blood work. I encountered four people, fronted by computers, whose eyes held steady to their respective computer screens. No one looked up; no one gave me a single sign of recognition, not even a fluttering eyelid. What are they doing? I wondered. After a long wait, and after finally getting the attention of one of the computer “appendages” –– by coughing and waving my hand –– she looked up, blinked, and stared straight at my chest.
I am reminded of auto mechanics; many of whom aren't really interested in talking to their customers. They believe that human reports are not to be trusted, and think they’re better off going straight to the transmission or brake pads. They refuse to waste time listening to owners’ superstitious and neurotic complaints about their precious junkers.
With the advent of electronic health records, we may be entering a period of time when physicians behave much the same as auto mechanics. “Just the facts, Ma’am” will be replaced by “Don’t have time for verbiage.” Warm and empathetic facial expressions will be replaced by furtive glances while the physician remains glued to an iPad screen.
The name Mercedes may sound classy, but this newfangled doctor might not be the most sympathetic physician. He doesn't want to hear your complaints. If he has any questions about how your body and engine work, he'll simply check his computer –– and skip getting greasy working under your chassis.
Yep, electronic medical records are replacing paper records whether we like it or not. Doctors who agree to adopt these new programs are rewarded with payments from the federal government of up to $44,000 over five years. Doctors who say no will face reductions in their Medicare payments. According to internist Ann Marie Valinoti in “Physician, Steel Thyself for Electronic Records,” The Wall Street Journal, October 2012, “tests that once took seconds to perform on paper now require multistep points and clicks through a maze of menus.” One of her colleagues commented that this is all about taking care of the chart, as opposed to taking care of the patient.
But it will certainly be more efficient. Right? Dr. Dennis Gottfried: “Electronic Medical Records: Their Time Has Not Yet Come,” Huffington Post, Oct. 29, 2012, reports that converting to an electronic record system in a typical primary care office involves physician and staff time, goes on for months, and decreases office productivity by 30 percent. Even when the new system is fully implemented, office efficiency still decreases because data must be entered during every patient encounter. So they are expensive to buy, time-consuming to implement, and decrease office efficiency. But, according to Dr. Gottfried, they have one redeeming quality: They allow the doctor to charge more for the same services!
One of the major problems is the lack of communication between computers built by different manufacturers. I recently went to my primary physician's branch office for treatment. The nurse asked me what medications I was taking. I tried to recall them but thought I might have forgotten one. She then went to the computer to check with the main office, but was unable to find my records. When I later saw the physician, she also had difficulty with the computer and finally had to call the main office on the telephone to get the information she needed. All of this took a lot of time.
If lack of communication between computers is one of the main problems, perhaps we need a unified government system. This would help with communications for the time being, but the competitive marketplace will probably produce better systems down the road. In any case, these problems will be worked out eventually and the electronic health records could be superior to the good old days when people wrote things down.
But will that translate into better health care? Will the physician use the freed-up time to interact with the patient or will more patients be added to the practice? And if a physician in training has a computer as a partner, will he or she still learn to interact with patients in order to reduce their stress levels and give them hope?
Theoretically, electronic records should allow the physician to save time and use that time for conversation with the patient, including a dose of empathy. A good number of doctor visits result from stress and somatoform illnesses. An understanding attitude and practical advice can help prevent problems, and a reassuring tone of voice can give the patient a real boost, whether it is placebo-induced or not. Believing in something is helpful, and strong beliefs can stir up our chemistry and push our neurotransmitters to work harder.
I recall living in a small Texas town where the visiting physician was an icy, left-brained type who thought a smile would permanently damage his face. I suspect he was one of those fellows who would rather dissect frogs in the high school lab than play touch football or chase girls. As a result, several of the townsfolk went to a personable young veterinarian for their health care –– as well as their animals’ health care. (True story).
Once these glitches are worked out, will electronic record-keeping result in better care, or will it add too much complexity to the system? Dr. Scott Silverstein, in a Letter to the Editor of The Wall Street Journal, February 2009, states that the United Kingdom had already spent 12.7 billion pounds on electronic record-keeping, as part of its socialized medical scheme. He states further that the UK still does not have a working national technology system but instead has a major information technology quagmire. “Except for few exceptions, it is largely a disaster,” Silverstein said.
Let's hope we can do better. I will still take my car to my local auto mechanic, even if he remains mute, and I’m not expecting a hug from my primary care physician. But mouse clicks when we’re feeling down just won’t hack it. Eye-contact and a little respect would be appreciated. We can’t afford to do away with empathy in the practice of medicine.