Saturday, July 13, 2013

Digitization and Future Shock

Digitization,  Older Physicians, and Future Shock
Future shock…the shattering stress and disorientation that we induce in individuals by subjecting them to too much stress in too short a time.
Alvin Toffler (born 1928 ),  American writer and futurist, known for his works discussing the digital revolution, communication revolution and technological singularity, In Future Shock (1970)

Technology is making it easier to monitor doctors' work as patient details are compiled electronically instead of on paper charts.

Anna Wildde Matthews,  "Hospitals Prescribe Big Data to Track Doctors at Work, " Wall Street Journal,  July 12, 2003
The other day I met a  60 year old  cardiologist employed at a major medical center.   The center had recently installed a computer system.   All employees,  including doctors and their medical staffs,  had to undergo an intensive training program to teach them how to use the system.  

Our conversation, as nearly as I can recall, went like this;
Cardiologist:  At first,  I just couldn’t do it, and I’m still having a hard time adjusting.  My brain doesn’t work that way. I’m an intuitive guy.   This computer system cuts my productivity by 40%.   I have to stay over, sometimes until 9:30PM to enter all the data required from a routine visit.  To learn to use the damn thing,  I spent 15 hours of training with a group of older guys my age.  We agreed the psychological trauma of adapting to the electronic medical record and changing the way we practice will push us out of practice sooner than we planned.
Me:  Do you think it improves patient care?
Cardiologist:  Theoretically, Yes.  Practically, No, at least in my case.  It’s great for gathering information.  It’s terrible in taking time away from patients.    You have to concentrate more on entering the data correctly than examining and listening to the patient.  It’s a distraction.  It gets between you and the patient.  The computer is an exacting master.  It won’t let you do what you should be doing  until you enter all the data correctly according to its rules.  It requires an obsessive-compulsive, menu-following mindset and demands computer skills I don‘t have.
Me:  But surely,  it has positive features.
Cardiologist:   Yes, in selective circumstances, like an emergency when a patient is sent in for a stent, and I need a quick summary of the previous history and medications.    Then it is useful, and I wouldn’t, maybe even couldn’t,  do without it. And it is useful in updating medical records.  Otherwise, it just slows me down by forcing me to enter data rather than doing essential clinical things.    In the office setting, it completely transforms the ebb and flow of the practice.
Me:    But isn’t that what medical assistants and other scribes are for?
Cardiologist: Of course.  And I must admit it gets the whole staff on the same page,
Me:   Anyway,  you have to do what your hospital employers say.   They need a record to comply with federal regulations, to  make sure their chargemaster knows all charges,  and to track the effectiveness of care,  outcomes  and your performance.
Cardiologist:     I know, but tracking my performance bothers me.   You can’t judge a doctor by data alone. There are too many intangibles, too many gray zones. And I don’t like being second-guessed by an impersonal system that judges the way I handle patients.  What he hell does it know bout what took place in the exam room?  It doesn’t improve my performance. It distracts from it. But I suppose if there is no struggle to adapt to change, there is no progress.    And for us older guys no weaned and honed  on the computer, it is a struggle.
Tweet:   For older physicians, digitization of medical offices,  can be a trying,  distracting, frustrating, and transforming experience.

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