Electronic health records changing the character of the family doctor

Electronic health records changing the character of the family doctor

Summary: Because my doctor's trying, desperately, to commune with the infernal machine, he's losing his most valuable and unique attributes -- his bedside manner and his attention to patients.

TOPICS: Health

I am incredibly fond of our family doctor. He's one of those old-school docs, who'll actually take time with you to discuss everything you need. He genuinely seems to care, and he'll never, ever rush you to get on with the next patient.

I love that. I haven't even minded spending a little more time in the waiting room, knowing that he's giving the patient he's currently with the same attention I'll receive when it's my turn. But it's also proven, recently, to be a bit more of a problem than it was in the past.

He's an old fashioned kind of guy. When you walk into his office, there's an ancient (from the 1960s) console TV in the corner, which serves as a table. Sitting on top of that is an only slightly less ancient portable TV (from the 1980s). That's been the extent of my doctor's office's technological prowess until recently.

I suppose he's seemed more curious about technology for the past two years or so. After all, at each visit he's sought my opinion on the newest smartphones. I thought he was just making conversation.

But now, our family doctor has discovered computers. My doctor -- like most doctors these days -- has decided that he needs to keep computerized records. For one thing, the paper records take up way too much space in his tiny office. My doctor now has a shiny new laptop that he rolls from examination room to examination room.

Lately, instead of having his full attention when I go in to see him, a good two-thirds of his attention is riveted to the screen. Instead of a considered response to a question, I often get a "Yeah" or an "Uh, huh," sometimes coupled with a mumble of some sort as he tries to find whatever he's trying to locate on the screen. It's hard to tell if he's even heard me.

I had a friend who used to sound exactly like my doc does nowadays. My friend would call me on the phone, and then only give me a fraction of his attention. His excuse was that he was killing Flood in Halo or raiding in World of Warcraft. Why did he call me to begin with? I guess he needed to multitask his boredom. That's what friends are for.

Because my doctor's trying, desperately, to commune with the infernal machine, he's losing his most valuable and unique attributes -- his bedside manner and his attention to patients. Forget about eye contact in 2012.

Worse, visits have ballooned in time. It is absolutely impossible to get to see him with less than a three hour round-trip committment. His office is only 15 minutes away, and the usual appointment used to take about an hour -- so I'd use up an hour and a half when visiting with him.

Now, it's three hours. No joke. It's a day killer. Even if I call ahead to be sure he's ready to see me, he's never, ever even close to on-time. For a guy who has historically always been a bit behind on his daily appointments, he's now incredibly behind. The computer is slowing him down. A lot.

Aren't computers supposed to be helping medical professionals do things more quickly and efficiently, and improve patient care?

I've cancelled appointments with my doctor when I realized I just couldn't take half a day off. The other day, I had to leave his office, after already waiting a really long time, because I had to get to another appointment.

To be honest, I couldn't tell you if his records are any better. Sometimes what's been recorded in the computer seems wrong. Sometimes, information is just not there, when I know we discussed it at the last appointment. When I ask him or his medical assistants or nurses about something, there's usually grumbling, a dive into the computer screen, and an expression of bafflement at the end. They ask the same questions about health history every time, so what's the point of the electronic record, anyhow? In any case, it's not helping this guy or his practice.

There's the rub of all this new-fangled computer technology for old-school country doctors. Sure, the theory is that it will help, but many of these professionals are really ill-prepared -- both in terms of their own skill, and in the way they've practiced medicine all these years -- for what electronic health records will do for their rhythm.

I'm sure younger doctors, doctors raised like the rest of today's kids -- with tiny screens surgically attached to their hands -- will be comfortable multitasking between the EHR screen and the patient. But the seasoned doctors, the professionals we cherish and trust, those guys are losing their way. They're losing some of their helpfulness. If they keep taking three hours per appointment, they're going to lose patients. There's a chance they might come up to speed someday, but who has the time to wait?

We need EHR, no doubt. However, there may be a price paid that's not measurable in dollars.

I kind of miss my old doctor, the one who was perpetually a little scattered, but didn't have his head in the computer. I felt safe with him. This guy, well, I just feel kind of annoyed and a little sad.

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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  • Your doctor didn't decide to use a computer in his practice.

    The Federal Government is forcing this upon him. If he doesn't use computers, he doesn't get paid.

    I provide IT services to many doctors. According to the government, a doctor who spends more than 15 minutes with a patient is going to go out of business. Likewise, each doctor needs to have three full time support staff to administer the EMR system to make sure that claims get filed correctly and in a timely manner. Younger clinics with younger staff aren't as effected here because they can cope with the computer much better than a practitioner who has been in the field for 25 years or more. The day of spending quality time with your doctor is going to be an artifact as you're more of an administrative task than you are a medical patient.
  • Of course... now I see...

    Of course, now that I read a bit more about you - you're already in the loop on the whys! :)
  • Which EHR vendor is your MD using?

    There is a huge difference between EHR systems in terms of learning curve and usability.
    eClinicalWorks is one of the largest vendors. We evaluated them and did some Googling and realized their reps push it as the end-all-be-all solution. The other practices we spoke told us eCW was a nightmare to learn and use everyday, even 6 months after deployment. And they all told us that you get what you pay for does *not* apply to eCW.

    We went with a much more affordable cloud EHR vendor based in NJ. The training was hands on and on site. Support is terrific. And most importantly, the way the system is designed doesn't turn our docs into typists with their heads buried in the computer all day.

    Next time you've set aside 3 hours to see your doctor (gasp) sneak a peak at his screen or just ask him the vendor. And tell him what you do, I'm sure he and his staff are looking to vent their frustrations.
  • Don't you wish you had V.A. health care?

    It's funny - despite the teaprtarians constantly screaming about the evils of "socialized medicine," I am regularly seen by Dr. Hernandez -- the V.A. assigns you a personal doctor -- within 15 minutes of my appointment time. He's in his 60s and completely computer-capable. As the private medical care system disintegrates, I wish everyone could V.A.-style care. I especially wish my wife could. Her medical care costs us more than all our other bills put together. Thank you, Republicans!
    • Wait until it is free

      You think your Medicine is expensive now, wait until it is free. Hopefully you will be one of those that are denied a lifesaving technology because you’re old and not economically viable. Liberals! You'll never get a brain now.
  • EHR is not the enemy

    I work for one of the HMOs who pioneered the use of Electronic Health Records. I am not a doctor myself, but I see my doctor regularly and he easily uses our system to record standard data about our encounter that can help spot trends across a large group of patients. He enters information our pharmacy needs to give me medicine and make sure everything I'm taking works together with no bad interactions. When I get a referral, the specialist has full access to all my x-rays, MRIs and various lab work in an instant. I never have an appointment where the records haven't been delivered to the doc ahead of time, like used to happen with paper records. The trending, the instant access, the full history of my complaints at he docs fingertips... all are huge benefits to aid in your care. MY doctor does have the ability to ask questions, look me in the eye and use his medical tools all at the same time. The doctor not having the skills to both work with you during your encounter and use your computer-based medical record have nothing whatsoever to do with the ability of EHR systems and everything to do with extremely intelligent people who know the Latin names of every part of your body but find a computer mouse confusing. Doctors are smart people. However, a doctor who still has a 1960's TV in his office is a doctor I would run away from very quickly. The medical profession is a fast-moving environment. Doctors have to stay up to date on the latest discoveries, procedures, tools and treatments. If he can't handle it, it might be time to retire. It's certainly time to pick a new doctor.
  • Truth

    I am a 56 year old doc who is technically proficient. However, I do like spending time actually talking to my patients and getting to know them. The government has mandated that unless we use EHR, our Medicare, and eventually most likely, all payors, payments will be reduced. I can do EHR, but I do not like what it has transformed the process into. A medical visit is now a checklist. Patients do not tell their story, we just fill in the blanks. Much of it is templated. It is difficult to find info from previous visits due to the large volume of info that is falsely entered. Yes there are improvements, but we do not communicate with our patients and other health care professionals like before, we just stare at screens. The programs are not written for our use, they were designed for data mining and manipulation. Promises were made, but like our politicians, many have not come true.
  • I still know of old school doctors who are largely computer free

    It's a dying breed for sure, but they still exist. And their attention spans seems infinitely broader, as if by magic.
  • ACA IT Requirements Are Great

    Doctors should use computers. My Mother-In-Law was nearly killed 3 times because her doctor didn't do a drug conflict check. My wife was nearly killed by a similar failure. My father was nearly killed a number of times for similar reasons. Computers can prevent that. I was savvy enough to save my wife and her mother. My mother saved my father. How many dead are there because family members weren't savvy? 45,000+, they tell us, every year. The Federal government needs to require doctors to do it because they are too damn lazy to do it otherwise. If they kill you what recourse do you have? Suing for $ doesn't get your loved one back!
    • Patient stories

      Charles - I'd love to hear more about your family's incredible story of near-misses in the health system. Would you reach out to me through Twitter @pfpresscenter to start the conversation?
  • Doctors should always face their patients. EHR's should just work.

    About 4 years ago my Father became quite ill and I spent a lot of time going to doctors and hospitals with him. He was taking over 20 prescription drugs at the time, when we visited small private practice doctors they would spend about 10-15 minutes out of a 20 minute visit.
    This is a great example of why EHR's are needed, a good EHR could have cut the interaction searching on drugs down to a second and left time for more important work.

    When we visited a large clinic in NY (which had some of the best doctors in the world), the doctor spent a full 20 minutes out of our visit with his back facing me and my Dad in the exam room while he worked on some enterprisey EHR that was running on an old Windows machine built into the wall of the exam room (as a software developer, the EMR looked like one of the worst video games ever made with tons of popup windows rioting across the screen). Even though this Doctor was one of the best, most experienced, most empowered to treat specific problems my Father was having, we both felt that the guy completely ignored us during the visit and couldn't have cared less about us or my Father's health problems. This is a great example of why EHR's can suck, they distract doctors if they are poorly designed.

    I was inspired to work in the healthcare tech space after spending months experiencing this process. I strongly believe that mobile devices such as the iPad, iPhone and other mobile devices will give providers, support staff, and patients the tools to communicate effectively and cut through all of the noise surrounding healthcare. If we can connect the healthcare provider, their staff, and patients everything else like reimbursement and regulation will just get automated and fall into place so people can focus on their health and well being.

    Michael Nusimow, CEO and co-founder drchrono
  • Electronic health records

    i would like to sue the person's that can up with this what you say they have let hackers steal my info in the dam cloud and did not tell me about nov 29 they were told july 9 so no no no no no no no this all so need to be shut down for good
  • My Doc is a young fellow

    Can't be over 47.
    I have known him since he was 8.
    He has managed to get into the electronic era and has become a good touch typist.

    He says " Just moment while I type in this info" or " I will look that +++ up ", and it all works well.

    He is better at computer stuff than I am as he is not of the slide rule generation like me.

    I have tried to find something about him to moan about but I have failed miserably.

    Must get back to playing around on my Ubuntu OS Computer now.
    Good Health to all of you.