Tuesday, June 19, 2012

When We Glue Doctors to Computers

True story: last night, I woke panicked, wondering if I had closed my charts and checked on a patient’s results.  It was 1 am.   I stared at the ceiling.  I tossed and turned.  Realizing I had to concede defeat,  I got up, fumbled to find my keyfob, then realized I had to turn on the light to see its password because the damn thing isn't backlit, logged in bleary-eyed to my home computer, and clicked away.

I had.

Then it dawned on me: I am suffering from Post Traumatic Dashboard Syndrome.

The signs of this syndrome are everywhere.  Doctors working feverishly behind computer screens clicking this way and that as their daily lives and workflows are manipulated by ever-increasing requirements for documentation tied to electronic medical record.  Lives depend on it.  So do dollars.   And, some day, so will pay. 

Data mining is health care’s de rigueur fashion statement.  We measure now because we can: mountains of data from mountains of sources, arranged neatly into a productivity dashboards comparing this month data to last; this year to last.

But we should ask ourselves where’s the data field for teaching?  Where’s the data field for face-time with the patient?  Where’s the data field for staying late?  Where’s the data field for taking call?

Where’s the data field for sleepless nights?



Anonymous said...

Very good thoughts. I have to add that many doctors may also suffer D.A.D.D. / D.A.D.H.D. = Doctors Attention Deficit Disorder / Hyperactivity Disorder. I learned this from working on the hospital floor and in a pharmacy. The lives of doctors are so stressful with an enormous amount of work being thrown at them each day. With technological advances these days doctors are forced to work even on their time at home just to try and keep up with the workload and the emergencies that happen. Doctors can feel so rushed from all of the activity that they might inadvertently forget to sign a form or Rx they filled out. Small details. My heart goes out to doctors. I experienced a similar phenomenon when I was on a busy unit wondering if I charted something or signed all my flowsheets. I wish healthcare would be less stressful, but thank God for those special moments that make it all worthwhile.

Margaret Polaneczky, MD (aka TBTAM) said...

I used to be able to sleep soundly knowing there was a pile of charts on my desk because my nurse had already flagged the urgent labs for me and they were all handled. Now no one pre-screens anything for me, and my inbox just keeps filling up, and I worry I may miss something urgent. Like email, I like an empty in-basket so I never feel like my work is done.

david said...

last week for the first time i had an appointment where i was glad that my doctor had his face glued to his computer screen. we were talking about the size of my aorta and my ejection fraction and the size of my left ventricle and he was able to show me and pull up the sizes from the echo and ct from 4 years ago and then again from 2 years ago and we were able to sit at his computer and talk about it. there seem to be so many benefits to the clicking.

Anonymous said...

With a well organized paper chart that same doctor could have done the same comparison excpet he could have actually had the 2 pieces literally side by side and showed you a direct comparison. The computer added nothing to that encounter. Now if he pulled up actual images, that is cool, but EMR didn't really do that part either.

david said...

clinically it may not have added anything. i am not a medical professional so i wouldn't be able to judge- but i do know from my experience that the biggest cost saving to my personal healthcare is me leaving the doctor feeling strong and confident. and that it did help to do. perhaps my doctor could have showed me my chart and test results before- but he hadn't. but he has taken to the new technology in a way that has helped me. it is also great, to me, that now my electrophysiologist, cardiologist, primary, and oncologist have easy access to any and all tests that i have had done, and dont have to wait around for a fax or a doctor to return a phone call.

a while back i posted on flaws with my doctors emr- for example the medication list they print off for me to review when i have an appointment shows the same exact medication and dosage twice- a human making that list would catch that.

from my perspective, my emr has done nothing but make my visits more productive. this patient feels more confident [whether valid or not] knowing that his healthcare record is a complete picture of his history and easily accessed by his medical team.