Published in Medscape
Nov 18, 2013
EHRs Can Impair the Patient Relationship
Some doctors see electronic health records (EHRs) as a giant headache and a barrier to good relationships with patients, whereas others are convinced that it can assist in efficiency and accuracy and still allow doctors to relate well with their patients. Medscape’s recent article, Do Your EHR Manners Turn Patients Off?, provided a springboard for doctors to air their strong reactions to this challenging issue.
Many physicians believe that there is no hope and that the EHR inevitably destroys any chance of building a constructive patient relationship.
“EHR has turned us from MDs into data entry clerks! We have gone from being a medical practice to an IT firm,” wrote a harried ophthalmologist.
“I feel less satisfied at the end of the day now. When patients are all gone, I’m typing, spell-checking, and doing autocorrections,” added a psychiatrist.
A neurologist proclaimed, “The measures of quality [in EHR] are based on checked boxes, not real outcomes. They have to be, or it fails. Simple is always better!”
“The most important keystroke is to push the PC aside and face the patient directly,” quipped an otolaryngologist.
Another physician came up with a very timely analogy: “I live in a town that has passed legislation criminalizing texting and driving. A driver is more impaired and distracted when texting than when intoxicated. EHRs and the practice of medicine should be no different. Do you really believe that your physician is actually concentrating on the patient in front of them while their attention is primarily focused on entering data in a computer?”
And a grim internist grew dystopian: “Documentation has become more important than human interaction. We are becoming more and more like the machines that we use, or rather, the machines that use us.” A psychiatrist agreed. “It is a concrete manifestation of the dehumanizing process in medicine that has been going on for years,” he wrote, crystallizing the siege mentality that many physicians felt.
That psychiatrist then issued a call to arms: “It’s time to tell the practice managers, insurance companies, and efficiency consultants that patients expect and deserve a real physician who is a caring human being and is able to take the time and provide the human element that is a major dimension of healing.”
Still, the annoyance of the EHR may not bother all patients equally. “They [teenagers] won’t notice you looking at a screen because their peripheral vision isn’t that good, and they never break their texting trance,” joked one physician, who then continued in a more serious vein. “This EHR [problem] may be a transient issue; it certainly doesn’t bother the younger generation.”
Ways to Make EHR Data Entry More Patient-Friendly
Other doctors felt that there were ways to make the EHR less intrusive and offered tactics that had worked for them.
One internist, who has used an electronic medical record (EMR) for 15 years, described the system he uses: “I inform the new patient, ‘I’m just going to get some background information, and then I will talk to you about why you are here.’ Once the database is completed, I print off the sheets and conduct the history and physical in the same manner I have done for the past 38 years.”
Another internist suggested developing the necessary skills to assist in the process. “I touch-type, which I highly recommend learning. I can maintain eye contact while entering their history,” she wrote.
Some found that including the patient in the process of collecting and viewing electronic information was a helpful practice. “[Older] patients feel much more comfortable with the computer when I pull up their actual scans on the monitor and use them to explain their disease…For many patients, the computer is not only an accepted but welcome presence,” wrote an oncologist.
A gastroenterologist compartmentalizes sessions, but this increases the potential for increased busywork later. “I leave the computer out of the exam room and take notes as necessary, then complete the EHR after the interview, while my assistant is performing her tasks with the patient,” he wrote.
One primary care physician decided that rather than try to minimize the presence of the EHR, it was wiser to enlarge it and use it as a tool to improve the visit. “I have a 32-inch monitor screen on the wall and wireless keyboard and mouse. It sucks the patient into their record and is unmatched for patient education,” he wrote.
A neurologist had a different concern: privacy. “I resent putting my medical records into the cloud as well as those of my patients. It makes true confidentiality an ideal of the past…There is no guarantee that any of the information in the EMR is truly confidential,” she wrote.
Others dismissed concerns and lauded the more comprehensive and lasting notes compiled by EHR. One psychiatrist even described how the EHR is a clear improvement on handwritten notes: “I have a lot of stuff in the current note that used to be buried in the chart (or omitted). Every patient gets a printout of today’s interim history and the proposed plan, as well as a list of meds and diagnoses.”
For some physicians, the future looked brighter than the present, and they speculated that new technology and a rapidly changing society might alleviate most of the current discomfort with EHRs.
Many doctors wanted a full-time assistant to fill in the EHR while they perform the examination. Because this kind of help was not feasible for most, some physicians mentioned that the use of speech recognition software might alleviate some of the current problems.
Although no one was completely satisfied with this technology as it currently exists, there is at least some hope that improvements in this technology may go a long way toward freeing a physician to interact more directly with patients.
Others posited that the EHR problem might be obviated by the changing expectations of today’s young people and that the younger generation’s dependence on electronic screens made them comfortable with EHRs.
It seems nearly certain that the future will bring increased expectations that all information discovered during a medical visit will immediately be entered and stored electronically. At the same time, it’s important to keep in mind the insights of many successful practitioners who have grave concerns about the maintenance of trust with patients. In the brightest possible future, new technologies will preserve or even enhance the personal connection between doctor and patient.
Published by Medscape, Nov 18, 2013.