Christians celebrate the season with a rich tradition of church services which feature Bible readings about Jesus’ birth and special music. And almost 300 years ago, a musician combined these traditions to create a familiar and often performed work of music.
updated for Advent 2022, which starts on November 27.
The season of Advent, which comes from the Latin word adventus meaning “coming” or “visit”, begins four Sundays before Christmas and ends on Christmas Eve. Advent is the beginning of the liturgical year for Christians. (Liturgical, from liturgy, which means the forms and functions of public worship.)
What is Christmas?
Christmas is both a secular and religious holiday. For those who observe it’s spiritual significance, Christmas is celebrated as the day the infant Jesus Christ was born (although Biblical scholars doubt that December 25 is exactly the correct day.)
Christians celebrate the season with a rich tradition of church services which feature Bible readings about Jesus’ birth and special music. And almost 300 years ago, a musician combined these traditions to create a familiar and often performed work of music.
quote from Isaiah 9:6; graphic from LIGHTSTOCK.COM, affiliate link
Handel’s Messiah
George Frideric Handel used this scripture from Isaiah in his famous work, Messiah, first performed in 1742, and which millions of people have heard or sang since then. The entire lyrics of Messiah are derived from scriptures from both the Old and New Testaments that describe the birth, death, and resurrection of Jesus.
Handel’s father was a barber-surgeon. Barber-surgeons were physicians in medieval Europe, who as the name suggests, cut hair and performed surgery, often treating wounds from war injuries. Eventually, surgery and barbery became separate occupations.
The association between barbers and surgeons goes back to the early Middle Ages when the practice of surgery and medicine was carried out by the clergy.
But in 1215, a papal decree ruled that priests could no longer partake in any shedding of blood. Because barbers were accustomed to using a razor, it was presumed that they would be skillful in carrying out any treatment that involved cutting the skin, and so the practice was taught to them.
Handel’s father, Georg Handel, was a barber-surgeon, a term for physicians in the middle ages who did surgery and cut hair. Surgery was primitive and dangerous due to no anesthesia and no antibiotics to treat infection. Most surgery was done to treat war injuries.
The increase in physician burnout has been directly linked to the introduction of electronic medical records.
You’re probably used to your doctor’s office using an EMR, electronic medical record (also called EHR, electronic health record) . By now most clinics, private medical offices, hospitals, labs, imaging centers, and other healthcare settings use computers exclusively for everything from scheduling, communication, to documentation and billing. If you are a young adult, you may not even remember a time when medical offices and hospitals used paper records.
Do you remember the stacks of charts in doctor’s offices and hospitals?
Dr. Danielle Ofri, author of several books about healthcare delivery, wrote an astute opinion piece about EMRs for STAT which I encourage you to read. I’m going to review her post adding my own ideas, , with the goal of helping you understand why we doctors, and maybe you, have a love/hate relationship with computers in healthcare; as Dr. Ofri says about electronic health records,
they all have their breathtaking assets and snarling annoyances
Dr. Danielle Ofri
In her piece, Dr. Ofri refers specifically to the use of electronic records in hospitals, but the issues are similar in clinics and other settings.
Breathtaking assets
more efficient storage of records than paper (taking up less physical space and time for sorting and filing)
ability to generate reports
improved hospital efficiency and financial margins (possibly by the ability to analyze data and generate reports)
able to analyze the health needs of large numbers of patients, called population health, so health systems can plan for and offer needed services more efficiently
communication- the ability to contact doctors by email, get test results through a portal, schedule appointments online, order med refills, etc.
legibility and standardization in documentation
Snarling annoyances
changes the way doctors work and make decisions; current software often does not reflect the way doctors are taught to approach patient diagnosis and treatment
less efficient retrieval of data than paper (due to larger amounts of data, which may be redundant)
little evidence yet that use decreases complication rates, or improves patient care in general
less personal interaction with healthcare professionals when communicating through a portal
increased time spent documenting on a computer , much of it simple data entry, compared to writing on paper
But the greatest disadvantages attributed to the use of computers in the medical setting, ones far more than “snarling annoyances” are
interference with doctor patient interaction and communication in the office or bedside; both doctor and patient may pay more attention to the computer than to each other
erosion of staff morale, often due to more time spent on the computer than with the patient, boredom with data entry, and stress of having to learn new systems and updates
contributing to physician burnout, which can have a negative impact on patient care
As Dr. Ofri points out, the EMR is not going away, and few if any of us want to go back to the old system, as annoying as the new system can be. The annoyances are slowly being worked through and resolved, and the assets are becoming truly helpful.
The younger generation of doctors who have never known a world without computers embrace their use readily. As we senior doctors wind down and eventually retire, we can pat ourselves on the back for being the generation that led the way into this strange new world.
You as a patient have a stake in this endeavor too. As already mentioned, being able to access your records, make appointments, manage payments, and send messages on your computer or mobile device brings efficiency and convenience to a process that formerly was time consuming and cumbersome. I now routinely use my doctor’s office portal for my own medical needs and my patients use my office’s online services . Here’s what you can do to help make EMR use better.
Use whatever online healthcare resources available to you. The more we all use them, the easier they will be to use, and feedback will help developers make them even more helpful.
Be patient with your doctors and other healthcare providers as they transition to EMRs, from one to another, or when problems occur. Like any piece of technology, they don’t always work perfectly, and occasionally they don’t work at all.
Give constructive feedback. A thoughtful critique will help more than irate criticism.
“you have a role and a vested stake in communicating your concerns, questions, and even grievances to the physicians who care for you; that without such information, your physicians cannot provide optimal diagnosis and treatment for you. ”
Danielle Ofri, M.D., is a physician at Bellevue Hospital, a clinical professor of medicine at the New York University School of Medicine, editor-in-chief of the Bellevue Literary Review, and author of the forthcoming book
Samuel Shem (pen name of Stephen Bergman, M.D.) is a novelist, playwright, and, for three decades, a member of the Harvard Medical School faculty. His other novels include The House of God, Fine, and Mount Misery .
In this novel about a hospital dominated by computer screens and corrupted by money, an idealistic doctor has one goal: to make medicine humane again. Here is an excerpt-
“Cynical? me? I feed on ideals, on ideal care. I’m so idealistic, to you I sound cynical! And I do not call ’em Electronic Health Records, ’cause they don’t help with health, and may well harm it. With a screen between you and your patient, you get distracted, right? It’s like texting while driving.
So, to remind us of the danger let’s call ’em EMRs, the ‘M’ for “Medical’. “
After a student asks why the computer systems at the VA (Veterans) and the Indian Health Service hospitals, both government agencies, are more user friendly, he goes on to explain,
“Nobody’s makin’ money offa it. So we all gotta get together and unhook care from billing. So nobody makes an obscene profit offa the sick.”
available on Kindle (affiliate link)
exploring the HEART of the health record
I hope you found this discussion enlightening; maybe it answered some questions you had about electronic health records and maybe raised some issues you’d like to know more about. Please contact me with questions and I’ll answer them in a follow up post.
watercress words by Dr Aletha 
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