Sunday, June 5, 2011

Human Narratives Versus E-Imperatives – When Computers Get Between Physicians and Patients

June 5, 2011 - The other day I phoned a primary care practice and asked to speak to the doctor. The receptionist asked who I was and why I wanted to speak to him.

I explained I was a doctor, and my wife had just experienced a sudden attack of diplopia. I was worried this diplopia might be a sign of a stroke. I needed advice, and I might want a referral to an ophthalmologist.

She asked,”Do you have insurance? We’ll need your insurance number to enter it ino the computer before you can talk to the doctor.”

I said I was not a patient, I merely wanted to chat with the doctor.

The receptionist said the doctor was busy and could not talk to anyone today. What I had to say was urgent, I said, would take only a minute, and as doctor I could keep the conversation brief and pointed.

She replied, “Don’t pull rank on me. Even if you walk in, we will not honor your request to speak to him.”

“Well, “I said, “Then simply leave a note on his desk.”

“No, “she countered, “I will not do that. He has to record all encounters on his computer. We are a computer-run office, you know. The computer takes priority.”

I complained to the supervisor of personnel at the health system. She said she was having trouble teaching newly hired receptionists and other front-line people about telephone etiquette. She observed that many of her new employees were not adept at talking to people. They were accustomed to texting to communicate. Phone calls distracted them.

The supervisor added that their health system had recently installed an electronic record system. Computer-entry was taking precedence over voice-entries. For the moment, at least, their employees were having a hard time adjusting, productivity was lagging, and receptionists were simply trying to protect the doctor against interruptions.

I do not know if my encounter reflects nationwide problems – bad telephone manners, loss of a sense of urgency, or lack of professional courtesies.

The supervisor and I agreed a seminar might be in order to instruct those at the front desk on how to courteously, expeditiously, rationally handle callers.
One person who conducts such seminars is Susan Keane Baker, who has written a book on the subject, Managing Patient Expectations: The Art of Finding and Keeping Loyal Patients (Jossey-Bass, 1998). Susan may be reached at 203-966-4880

The book maps out how to:

• Identify patient expectations

• Create positive word-of-mouth comments from patients and staff

• Enhance listening skills

• Respond effectively to patient complaints and adverse outcomes

• Build patient loyalty.

Passage of the health reform law in March 2010 may have changed patient expectations. Patients may have been led to expect they would have greater access, and that access would be accompanied by computerization of their records.
Universal computerization has been a struggle for doctors – installation costs average $40.000, staff must be trained in computer skills, productivity of the practice drops initially by 30% or more, EHR companies go out of business, EHRs do not talk to other EHRs, and whole patterns of practicing must be restructured (“For Physicians, Electronic Medical Records Continue To Pose Challenges,” Kaiser Health News, June 4, 2011).

Furthermore, doctor shortages, increased workloads, transferring patient records into digital form, and need for computer entry of all information is a pain. Computers, moreover, can dehumanize the doctor-patient relationship by making needs of the computer more important than needs of patients.

Computers placed physically or figuratively between the patient and the doctor can harm the relationship. Computer communication tends to be flat, impersonal, numeric, and abrupt.

The Obama administration has dedicated $27 billion to $30 billion in its 2010 stimulus bill to develop a nationwide interpretative computer system linking all doctors, hospitals, and other health care facilities, not to mention to creating personal health records for patients.

This is a noble national effort. Almost everyone agrees EHRs ultimately will be the way to go. After all, there can never be too much reliable information. But there can be too much reliance on computer documentation of every human encounter as the only way to communicate. The computer is not always the best gateway between humans. The patient’ story and the tone of their voice can speak volumes.

Something was displaced, missing, or askew in my encounter. It was the narrative. The doctor would have immediately understood without computer intervention.

Could it be that texting, tweeting, face booking, and other computer obsessions, with cell phones and other electronic devices glued to the ear, distract from a smile in your voice, the art of conversation, and good telephone manners?


kevinh76 said...

I hope you didn't really call a primary care doctors office where you are not a patient and ask for a phone consultation. If you did in fact do that, you deserve what the receptionist gave you and more! Do you really think the receptionist should interrupt the doctor spending his precious few minutes face to face with one of his real patients, everytime someone calls on the phone for advice? Is there some part of the story I'm missing here or are you just trying to dump on a primary care doctor (you'll have to stand in line for that) and his staff? If my staff did what this receptionist did, I tell her she's doing a great job and giver her a raise for keeping the office flowing smoothly.

Richard L. Reece, MD said...

Thank you for your comment.