The electronic medical record-asset or annoyance?

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.

Medical Record
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

Doctors like me, who did not grow up in the computer age, went through the entire medical education experience without touching a computer. For us , the transition to computerization while maintaining a busy schedule of patient visits, was difficult and stressful. The increase in physician burnout has been directly linked to the introduction of electronic medical records.

Boldly going…

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.

a graphic showing various mobile computing devices
a graphic from the LIGHTSTOCK.COM collection, an affiliate

Where you, the patient, fit in

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.

Here is the link to Dr. Ofri’s article-

The EMR has changed the doctor patient relationship into a menage-a-trois

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.

from my review of Dr. Ofri’s book -at this link

What Patients Say, What Doctors Hear

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

When We Do Harm: A Doctor Confronts Medical Error

Another physician explores the EMR

MAN’S 4TH BEST HO$PITAL By Samuel Shem

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.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

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Physician authors share the heart of health

Probably the most common non-practice activity that doctors do is write-like me, and other physician bloggers. Doctors write health and medical books and blogs of course, but they cover other topics too-finances, travel, food, family, parenting, spirituality, fashion. They’ll usually throw in their unique perspective as a physician in approaching these non-medical topics.

Physicians often do other things besides practice medicine. Many have hobbies and travel extensively. Many do spiritual ministry and other volunteer community activity.

I know doctors who dance, sing, play instruments, act, and do comedy. Others own and manage side businesses.

But probably the most common non-practice activity that doctors do is write-like me, and other physician bloggers.

When I started blogging 4 years ago, I knew few other physician bloggers, but the number has grown so large I know few of them now.

Doctors write health and medical books and blogs of course, but they cover other topics too-finances, travel, food, family, parenting, spirituality, fashion. They’ll usually throw in their unique perspective as a physician in approaching these non-medical topics.

And they don’t all write non-fiction; doctors write novels too, some of which get made into movies.

Books reviewed here- a list

I’ve reviewed or referenced several books written by physicians. In this post, I’m listing links to those reviews. along with a brief excerpt. I hope you’ll bookmark this page so you can come back and read all of them if you don’t get to them all now.

Enjoy exploring the HEART of health with these physician writers.

(This post contains affiliate links which, by paying a commission if used for a purchase, help fund this blog. )

The Point of it All

If you wondered why Pulitzer prize winning journalist Charles Krauthammer quit his medical career to write a political column for the Washington Post newspaper, you’ll learn the answer in his newest and sadly last book. He explained

“I left psychiatry to start writing…because I felt history happening outside the examining room door. I wanted to…because some things matter, some things need to be said, some things need to be defended.”

Being Mortal

Dr. Gawande poignantly describes this process by sharing in detail his  father’s cancer diagnosis, treatment, progression, hospice care and death. He shows how difficult a process this can be, given that even he and his parents, all of whom are physicians, struggled to come to terms with the reality of terminal illness and the dying process. Though they were all familiar with and experienced in dealing with the medical system, they still felt unprepared to face the decisions required at the end of life. But in the end, both he and his father felt at peace with the outcome and Dr. Gawande senior did experience “a good life-all the way to the very end.”

What Patients Say , What Doctors Hear

As a physician, this was not an easy book to read; Dr. Ofri does not hesitate to tell us physicians what we need to do better in our communication with our patients.

But she also makes it plain to patients that 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.

When Breath Becomes Air

This memoir is not so much a diary of what happened to Dr. Kalanithi as what happened within him as he confronted his own mortality and chose not to let it define the remainder of his life.

On the copyright page, “Death and Dying” is included in the list of categories for this book. However, you will not find “how to die” instructions here. Instead, you will learn how one man and his family chose to live despite knowing that he would  soon die.

Working Stiff

When she applied for a position in New York City at the NYC Office of the Chief Medical Examiner (OCME), Dr. Judy Melinek never imagined that decision would plunge her into the nightmare of September 11, 2001. She was at the ME office that day when the Twin Towers were attacked and fell, killing thousands of people.

Healing People, Not Patients

Health care professionals will find Dr. Weinkle’s concepts an attractive alternative to “burnout”, an encouragement to remember why we entered the profession in the first place, and a challenge to restore the personal touch that makes medicine truly an art. 

Patients will find explanations about why medical care is at times fragmented, uncoordinated, and unproductive, will understand the challenge that their own physicians face in providing effective care, and understand how they can be part of the solution. 

sharing the HEART of health

I thank my colleagues for sharing the HEART of health, both in the exam room, the operating room, the emergency room, the clinic, and at their own computer.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

Thanks for exploring the HEART of health with me.

                              Dr. Aletha 

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What Patients Say, What Doctors Hear- a book review

What Patients Say, What Doctors Hear helps patients understand the complexity of what physicians do in our encounters with patients and how that impacts our subsequent decision making and treatment decisions.

What Patients Say, What Doctors Hear

by Danielle Ofri, M.D. , an associate professor of medicine at the New York University School of Medicine and staff physician at New York’s Bellevue Hospital .  The book is published by Beacon Press

“What patients say and what doctors hear can be two very dissimilar things. The reverse is also quite true: what doctors say and what patients hear can be radically different. ”

I am so convinced of the truth of these two statements, that I have written several blog posts about physician-patient communication. So when I learned of a book that delves into this subject in detail, I knew I needed to read it; I was not disappointed.

As a physician, this was not an easy book to read; Dr. Ofri does not hesitate to tell us physicians what we need to do better in our communication with our patients.

But she also makes it plain to patients that 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.

doctor talking to a woman
photo compliments American Academy of Family Physicians

Dr. Ofri bases her conclusions on her own encounters with patients over 20+ years of practice, interviews with other doctors and patients, and published research on communication. In her book she explains

  • How the uniqueness and complexity of the physician-patient relationship impacts their communication
  • Why patients’ less satisfactory encounters with the medical system are often due to poor communication, rather than lack of caring and competence, but can lead to lawsuits
  • Why patients’ unfamiliarity of medical terms can hinder communication , and how differences in use of words between doctors and patients, and even between doctors can lead to misunderstanding

For example, Dr. Ofri relates an incident when she was still a medical student working in the hospital and came across the term “expired” to refer to a patient who had died. She had never heard the word used this way. Then years later, when she was an attending physician, she was confused when an intern from a southern state reported to her that a patient had passed during the previous night. Passed what?, she thought. In some areas of our country,  “passed” is commonly used to mean someone has died, but Dr. Ofri had never heard this.

Dr. Ofri discusses the placebo effect of medicines and treatments, and how expectations affect response to treatment. (The placebo effect means responding to  a treatment that contains no active medical substance.  Interestingly, placebo treatments “work”.)

She details the many reasons patients have difficulty adhering to doctors’ recommended treatment plans, such as cost, inconvenience, distance, and other factors unrelated to not understanding the seriousness of their condition, as one might suppose.

I was intrigued by the story of a hospital in The Netherlands which hired a woman to be the “Chief Listening Officer.” Her only duty was to listen to patients talk about their complaints or grievances  about their care, not to fix or solve problems, but just to listen. And it was successful; once patients felt they had been heard, they had no desire to pursue legal action and felt more satisfied with their care.

She also relates a program called Sorry Works!, a way to handle medical errors with mediation rather than lawsuits, also a successful program.

Dr. Aletha talking to a mother and her son
Talking to a patient through an interpreter makes communication extra challenging. (photo from a volunteer medical trip to Ecuador)

 

 

What Patients Say, What Doctors Hear  helps  patients understand the complexity of what physicians do in our encounters with patients and how that impacts our subsequent decision making and treatment decisions.

This book illustrates there are multiple detailed steps between

  • A patient’s problem and the best solution
  • The patient’s and family’s questions and the correct answers
  • The final (or sometimes current) diagnosis and the definitive,  best available ,or least toxic treatment.

 “The biggest take-home message is that both doctors and patients need to give communication its just due. Rather than the utilitarian humdrum of a visit, the conversation should be viewed as the single most important tool of medical care..a highly sophisticated technology. “

 

 

 

 

In this previous blog post I offer suggestions on physician-patient communication based on my years in practice:

Do you know the best questions to ask about your healthcare?

You know it’s important to tell us details of your symptoms, medical history, family history, habits, and other medical facts.   But besides medical information about you , we need to know

Your expectations about your care,

Your concerns about your care,

Your obstacles to getting care,

 

sharing the HEART of health and communication

 

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

 

                              Dr. Aletha 

 

 

 

These are affiliate links you may find helpful and which help fund this blog with a commission when a purchase is made using them.

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