Bedside manner in the days of EHR

Bedside manner in the days of EHR

Summary: For both seasoned health practitioners and newbies born with smartphones in their hands, the challenge is to still provide a sense of humanity while augmenting productivity with electronics.

TOPICS: Health

Last week, in Electronic health records changing the character of the family doctor, I wrote about how the character of patient care has changed since our old country doctor has started keeping electronic records.

For both seasoned health practitioners and newbies born with smartphones in their hands, the challenge is to still provide a sense of humanity while augmenting productivity with electronics.

The $47 billion Kaiser Permanente managed healthcare company has even gone so far as to develop a training methodology for EHR etiquette. It's designed to teach practitioners how to both use electronic tools and be aware there's a patient in the room.

Called LEVEL, it has five steps:

  • L -- Let the patient look on
  • E -- Eye contact
  • V -- Value the computer
  • E -- Explain what you’re doing
  • L -- Log off
While it may seem kind of silly to have to use acronyms to explain basic courtesy to adult medical practitioners, we see how mobile technology monopolizes everyone's attention to the point of rudeness on almost a daily basis.

It's no different in the hospital or clinic. People need to be retrained (or trained in the first place) on how to practice common courtesy where bright, shiny screens are involved.

There's a helpful video put out by Dr. Larry Garber, a Massachusetts-based internist, that can help you understand the LEVEL system in more depth.

Feel free to share this article with your favorite medical practitioner or country doctor, especially if they've succumbed to Bright Shiny Screen Syndrome.

Topic: Health


Denise Amrich is a Registered Nurse, the health care advisor for the U.S. Strategic Perspective Institute, and a mentor for the Virtual Campus at Florida's Brevard Community College.

Nothing in this article is meant to be a substitute for medical advice, and shouldn't be considered as such. If you are in need of medical help, please see your doctor.

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  • EHR

    I like the idea of the Electronic Health Record. There are many advantages, but the people who push it are not always folks who practice medicine. It makes no sense to have a doctor, who is trying to generate $200/hour or more in charges, spending his time inputting data into a health record when a transcriptionist at $25+/hour could do it faster and more accurately. Doctors make a lot of mistakes typing. While they type, they cannot look at you or examine you. They become slaves to "filling out electronic forms" rather than spending time examining you and analyzing your symptoms and physical findings. Some specialists can afford to have an assistant follow them and input the info into the lightweight laptop while they examine the patient. Unfortunately most primary care doctors cannot afford to pay an assistant to follow them everywhere in addition to all the other overhead. The EHR systems are expensive to buy and to maintain and update. Not all are compatible with hospital systems. Security can be a nightmare. If a doctor discharges you from his practice and puts a long note in the record, you cannot get the note removed even if you can prove the note is incorrect and was placed in the record for malicious reasons. This happened to two of my grandchildren. The note cannot be changed. The patient is allowed to place a note in the record disputing the reason for discharge, but what physician will see a patient after reading this disputatious record. Contrary to what President G.W.Bush and Hillary Clinton and others have said, the EHR is not a panacea for problems in our medical system. By the way I am a retired MD and I have used computers since the early 1980s.
  • Interesting.

    Hmmm... That's quite interesting. LEVEL? Where Medicine is going to?