Electronic Medical Records = Why Doctors Resist EMR Checklists: What Googlers May Not Understand

It sounds so logical. The doctor lists patient symptoms, types the symptoms into Google, and out pops an exhaustive list of diagnostic possibilities based on the medical literature. What could be simpler? What could be more ideal in sorting through medical information?

According to a journal Science blog, in a meeting of a group of Obama advisors that advises Obama on EMRs and other matters, Google’s CEO Eric Schmidt openly wondered why doctors haven’t embraced databases to help them sort through medical information. In a comment directed to Atul Gawande, MD, a surgeon and New Yorker writer, Schmidt said,

“So when you show up at the doctor with some set of symptoms, in my ideal world what would happen is that the doctor would type in the symptoms he or she also observes, and it would be matched against the data in this repository. Then this knowledge engine would use best practices, and all the knowledge in the world to give physicians some sort of standardized guidance. This is a generalized form of the checklists that you’re talking about…”

Gawande explained,

“I think part of the bafflement occurs because the folks who know how to make such systems don’t understand how the clinical encounter actually operates. A database is likely to return more information than a clinician could make sense of during a patient visit when there are '15 minutes to manage six problems.'

Still, he added, " the right kind of apps for 'for your iPhone or whatever the new Google one is' could be useful for doctors.”

Gawande might have added:

1) Doctors don’t like to type. That’s clerk work.

2) Doctors don’t like to place computers between themselves and patients. That depersonalizes the encounter.

3) Most diagnoses are self-evident. They don’t require a list to sort through.

4) Computer lists often contain more information that you want to know. Besides, not pursuing a lead might be used against you in a malpractice suit.

5) Inserting a computer into the work flow is expensive and disruptive and slows things up when you’re trying to see 30 patients that day.

6) Computers have their place, but when it comes to diagnoses in the course of a busy day, they offer few miracles, except perhaps, in a few isolated, difficult cases.