Guest Blog: A Patient’s EHR Point-of-View

Barry Comer, blogging at Thoughts/Rhythms, gives a poet’s impression of the EHR experience:
In June of 1966, several crew members begin dying from a mysterious depletion of salt, extracted from their bodies. The crew’s doctor anaylizes post-mortum and discovers by instrument, the phenomenon’s cause. 

Of course this is the fiction in 1966, envisioned by Gene Roddenberry for the 23rd century. The imaginary “tricorder” in the doctor’s hands is for wishful dreamers and possibly envied by my physician, in 2012. 

With the introduction of electronic medical records (EMR) to the patient/physician dialog, neither the future nor a “diagnostician in a hand” have arrived. Clumsy to learn, intrusive in use, EMRs in form and function are short-reaching obstacles, that chart their course with manual input and uncertain results. 

Some tools in the 21st century disappoint and others appear with malice. Because EMRs are still untamed and newly minted, their usefulness arrives as a mixed blessing. 

They say, “time heals all”, but our relationship is in trial to stay in the moment.

My physician is intuitive, intelligent and listens carefully. She possesses a black belt
in medical counsel, that appears clairvoyant. Her holistic relationship to my body and mind is why I call her my doctor. The EMR pushes that trust backwards. It conspires to break her gaze from me and worse, has taken certainty of our relationship, into the “getting to  know you” process again.

Not only do I depend on her words, I put trust in her eyes. But when they stray, I feel the magic leave by the tiny keystrokes and space bar taps, filling the exam room. Our agreed upon relationship is breaking and hear it in her sigh.

This was not the future promised and feel once again, that some technologies are better left in clinical trial, with release contingent on both aesthetic and functionality. Without both, advancement seems muted by imagined giggling of software authors in the bushes. 

Not all things advanced by the goalkeepers make for better analysis and savings. Growing suspicious has been supplanted with hopeful resignation. It may get better and after all, 
I may just have a cold.    
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Friday Morning Overload

Somewhere mid-morning on Friday I lost control. Things were perking along very nicely and then suddenly (or so it seemed to me), I was nearly an hour behind. Up until then even my EHR notes were signed at the end of each visit. Perhaps it is my German heritage, but my skin begins to crawl when patients wait more than fifteen minutes. For years it has been a matter of pride that they rarely waited longer than five or ten minutes and frequently they were seen within a minute or two of their appointment time. Nor did patients feel they were getting short shrift from me. My scheduling clerk knew her business and the patients well enough to pad an appointment when necessary. In the last three months that has not been the case. Hopefully this is temporary due to the extra time involved in learning our new documenting system but being behind brought me to a reflection on the importance of timely appointments.

Sometimes, no matter how good my intentions, the cards are stacked against me–Mrs. Jones lost her job and her mother in the same month; Mr. Bausier came in for a cold but just happened to mention the pressure sensation in his chest that seems to be more frequent and is associated with exertion; and in listening to Mrs. Roberts’ heart it is obvious that the rhythm is just not right. And all in the same morning. Other times, it’s more personal–I’m talking to a patient whose daughter went to high school with mine and we have to catch up or my favorite French national comes in who prefers to tell me her medical problems in her native tongue. Not because it’s better for her but she knows I need the practice. 

On Friday, my schedule was so off that by the twelfth of thirteen patients that morning my sugar was low, my mood was cranky, and my thought processes had slowed to a crawl. Frustratingly, somewhere in the brain fog I recognized those last two patients did not get my best care. Did they recognize my distress or just think that Dr. Nieder didn’t care about their needs? Statistically patients have a problem speaking up for themselves in a doctor’s office[1,2] and in my own uncomfortable state of mind it is unlikely I would have picked up on their discomfort!

Someday, hopefully soon, the office will find the right balance in scheduling for our new system. For now, I’m taking a lot of deep breaths and hoping that patients know I still respect their time and am struggling to give them good care under difficult circumstances. 
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Let’s Ring in the New to Get Back to the Old

While reading a blog post by Dr. Kent Bottles I was struck by a quote from Lewis Mumford: 

“For most Americans, progress means accepting what is new because it is new, and discarding what is old because it is old. This may be good for a rapid turnover in business, but it is bad for continuity and stability in life. Progress, in an organic sense, should be cumulative, and though a certain amount of rubbish-clearing is always necessary, we lose part of the gain offered by a new invention if we automatically discard all the still valuable inventions that preceded it.”

Although Mr. Mumford has been gone awhile (22 years), part of his foresight, as I understand it, is that technology should serve humankind and not vice versa. The more things change the more things stay the same. Technology is infinitely more complex which makes it incumbent on IT and medical professionals that it serve to improve patient care and not worsen it. While I am jumping on the EMR (Electronic Medical Records) and Medical Social Media bandwagon, I am anxious to see that it is done in a manner that serves the patient more than me, the IT guy or the hospital where care is given. So many of the EMRs that I have sorted through as a provider makes patient care HARDER, not easier. Perhaps this will improve when, and IF, our different systems can talk to each other but now it is difficult to find labwork, tests, and pertinent history when wading through thirty pages of printed material that has nothing to do with the patient’s problem. The important stuff gets lost in the minutia.

The EMR train has left the station and we will ultimately all be on board (how many transportation idioms am I going to use in this blog…). I see Social Media as a means to better care for patients, specifically as a way to return to patient-centered care and much more importantly, to get on the bus of participatory care. In The Social Media Course a well-known advocate for patient participation in their own medical care, e-patient Dave, addressed the fact that patients are the most under-utilized resource in healthcare. The best clinical teachers I had in medical school taught me that if I listened to my patients, they would tell me what was wrong with them. After many years of medical practice I know with certainty that no truer words were spoken. With the wealth of information on the web physicians and patients can work together as partners, a manner of practicing medicine that has very little down side.

To get back to Mr. Mumford, my vision for the future of medicine includes accepting what is new because it brings us back to what is old–taking care of the individual patient (the old) by utilizing the new (Electronic records and social media) and in the process creating partnerships with patients as well as other physicians and healthcare providers. This doesn’t mean that my “partnered” patient will get the inappropriate antibiotic she insists is necessary. But it does mean that patients may once again see me as something other than a prescription supplier and test taker. Dialog is so much more satisfying than one-way conversation.

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