Tuesday, April 19, 2011

How an EMR Emotionally Disengages Physicians from Their Patients

Preface: The following blog appeared in Kevinmd.com. I reprint it because it reflects my sentiments. I wish I had written it myself.

by Richard Barager, MD

“See me, feel me.”

Yes, that’s right, the title of a song played at Woodstock by The Who—at sunrise of the third day, no less—is the title of my post. The song begins with those very words sung in dramatic refrain, followed by four more: Touch Me/Heal Me.

The same four imperatives succinctly describe the essence of what patients want from their doctors. But in the age of the EHR (electronic health record), they may have to stand on top the exam table and ululate these lyrics at the top of their lungs just to get their doctors to look up from their laptops. And smash a guitar, too.

An article in a recent issue of The Journal of the American Medical Association reviews the Department of Health and Human Service’s ambitious plan for converting the nation’s paper-based medical record system to an electronic one.

“Meaningful use provisions will help improve legibility of clinical records, reduce prescription errors, improve adherence to guidelines, improve patients’ access to their records, and ensure that clinicians and hospitals are capable of exchanging clinical data.”

Laudable intentions, all. And in an effort to fast track this massive undertaking, a $44,000 bribe—er, incentive—has been allocated for each physician who purchases and implements (for about the same cost as the incentive) an electronic health record in his or her office by 2014. The article goes on to warn, like a surgeon obtaining informed consent, of the risks associated with this nationwide conversion.

“Many of these transitions will be poorly executed, some with serious consequences. Poorly designed or poorly implemented EHR systems can cause as much harm as good. Reports of failed adoption and patient harm are likely to emerge.”

And so on and so on, the author’s disclaimer mainly a congeries of tech snafus likely to plague this feverish, government-mandated rollout. I appreciate the heads-up on potential adverse effects, but he left a biggie off the list of unintended consequences: the decided propensity of digital health care records to emotionally disengage physicians from their patients.

Doctors ask patients to submit to unspeakable things: the carving of viscera, the infusion of poisons, the ghoulish machines we attach them to. Their consent to undergo such unnatural acts depends upon an irrational trust—irrational in that an emotional, rather than logical, connection between doctor and patient gives rise to it. Such trust is the coin of the medical realm, and the first step in gaining it is the authentic recognition of the basic humanity of the patients seated in front of us.

Experienced physicians establish patient-rapport in three main ways: eye contact, empathic listening, and touch. Note that verbal communication is not on the list; it’s not that easy to talk someone into trusting you. But the more we stare at our computer screens, the less eye contact we make. See me. And the more time we spend scrolling for lab results, the less time we spend in empathic listening mode, vicariously experiencing our patients. Feel me. The more our hands are on the keyboard, the less they reach out in a reassuring, comforting way. Touch me. And the less successful we are in establishing these empathic connections, the less likely we are to cure the conditions that caused our patients to come to us, like pilgrims to Epidaurus, in the first place. Heal me.

Don’t get me wrong; I’m not some churlish medical reactionary yearning for the halcyon days of Marcus Welby. We’ve had an EHR in our office for nearly four years, and I like it well enough. It got rid of our transcriptionist, freed up an entire room full of paper charts waiting to be shredded, and improved the flow of information to our referring physicians. I encourage all doctors to go digital.
Just remember to look up from the keyboard once in awhile and smile.

Richard Barager is a nephrologist who blogs at his self-titled site, Richard Barager.

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