Abhishek Pandey is a medical student at the Georgetown University School of Medicine.
A visit to the modern doctor’s office may look like this: You arrive at the clinic after making an appointment online. In the exam room, you sit across from your doctor, who is facing a computer screen. She clicks away at the keyboard, occasionally pulling out a smartphone and touching the screen a few times as you respond to her questions. Then, before you know it, the visit is over. Your doctor hands you a printout summarizing your visit and says that she sent you an “e-copy” as well. Your lab results will be ready to view online by the end of the day. She renewed your anti-hypertension prescription and sent it electronically to your pharmacy. Finally, she requests that you continue sending your daily home blood-pressure readings. The entire visit lasts no longer than 15 minutes. The physician leaves your room to see the next patient.
Rinse. Wash. Repeat.
Some look at this experience and marvel at how computers, powered by the Web, have added new dimensions for creativity and efficiency in health care. Others, however, look past the potential benefits and point to what we might be giving up.
In a March essay for The Journal of the American Medical Association, Caroline Wellbery voiced concerns that “we are in the process of working out an open marriage that will allow seamless incorporation of technology into our daily professional lives.” Physicians have given their tacit consent to computers, smartphones and any other technology that is widely seen as improving access to patient data and medical knowledge. But, writes Wellbery, in the pursuit of timely information-gathering “these devices deprive us of the very essence of presence, which is steeped in context…We may be surrendering our capacity to be in the moment.”
Can you be sure your doctor is paying attention to the details of your story if she is typing? What might your doctor miss while she is fact-checking on her smartphone? The doctor-patient relationship may be a misnomer if it accommodates a computer, and this distortion may have consequences if unchecked.
Many doctors share Dr. Wellbery’s concerns. Their experiences with computers have not been entirely positive. While policy-makers have high hopes for electronic health records (EHR) and other digital tools as part of our national health-care reform strategy, clinicians have more skepticism than enthusiasm for them thus far. Buying and installing an EHR is not cheap. And worse yet, those who overcome the financial obstacles quickly find other problems. They often report spending more time trying to navigate a poorly designed EHR system than talking with their patients.
In teaching hospitals, nearly all of the medical students tuck smartphones into their white-coat pockets. While students can use apps, such as DynaMed or ePocrates, to look up disease and drug information, anyone with a smartphone knows that apps can be as much of a tool as a toy. Are future doctors fully attentive during the “teachable moments” in the wards? Are they more concerned with looking up disease information than the patient? As the next generation of physicians graduate, many worry this new wave of electronics may be more of a distraction than a supplement.
The “human factor” has long been a concern for health-care technology. Doctors do not want to compromise their relationships with patients; they want to spend time understanding their concerns rather than software design.
So, what should doctors do?
First, they should demand cheaper, more user-friendly tools. Doctors should also question the overall utility of these innovations in improving patient care. But they shouldn’t discount the promise in these tools either.
As patients accrue data with each visit, EHRs could become more than just “charts.” A thoughtful, well-designed system would help doctors find meaningful trends and warnings for patients suffering from a variety of chronic illnesses, such as diabetes and high cholesterol. In a campaign to fight an epidemic of chronic disease, such information would be very valuable.
While intuition and experience may go a long way, today’s clinicians are dealing with an unprecedented amount of information. Some of their patients have complicated conditions that demand consideration of many variables. Better record-keeping and added computational power can empower them to effectively apply medical knowledge in such situations.
“Computers are useless. They can only give you answers,” Pablo Picasso has been quoted as saying. His sentiment reflects the ideal doctor-computer relationship perfectly. Smart, well-designed software and forward-thinking medical education will help. But, the keyboard and touch-screen are like the stethoscope and scalpel. They are only as good as their users.
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