Imagine you sit, eyes closed, at the opening bars of Mozart’s Lacrimosa.
You’ve waited so long to hear the Vienna Philharmonic.
The music stops.
Musicians type on computers attached to their music stands.
You catch your breath. What just happened?
Never mind. The music starts again. You drift into the second stanza. Finally, you get what you’ve been waiting for…and the music stops again. More typing.
Computers play a vital role in the music industry. And some musicians find ways to type and play, splitting attention between music and keyboard, like a one-man band. Apologists for musical computerization argue that computers are music.
Computers do play a big role in music, but no one sees them. Putting computers in front of the audience is garish. It ruins the experience.
Computers in Medicine
Computers play a vital role in modern clinical care. And everyone sees them.
Do we want to return to paper charts? Of course not. Have we figured out how to incorporate computerization into the sanctum of the doctor patient relationship? I’m not so sure.
I spend time apologizing during every visit. “I’m so sorry; I have to look at the screen right now.”
Granted, we had many apologies, probably more, with paper charts:
Sorry, I can’t find the report.
Sorry, I need to flip through your chart.
Sorry, I can’t read the doctor’s handwriting.
Computers have improved accuracy, audit and access to all sorts of data. But have they improved the patient care experience?
Doctors now spend as much time on their computer as they do with patients. Computerization and regulation rank as the primary causes of physician burnout.
Regulators love computer data. They can use it as a bludgeon to enforce managed care guidelines and performance targets.
But what about the patient experience?
Not everything that matters can be measured and not everything that can be measured matters.
The art of medicine is such a quaint idea. Technical success matters most.
But what causes most complaints to the college?
What do lawyers say is the best protection against lawsuits?
Communication. Patient experience.
Computers are wonderful tools. Have we learned how to incorporate them seamlessly into the clinical experience?
Patients love seeing computerized charts of their lab values. They love seeing a consultant’s note and reading a radiology report for themselves on the screen.
But they hate losing their doctor’s attention.
There’s something intrusive, almost immoral, about typing during a patient history of attempted suicide or domestic violence.
Scratching a few comments on a pad, while a patient reached for a Kleenex, used to go unnoticed.
Clacking away on a desk-top, arms twisted to the side, just doesn’t feel right. It’s like snapping pictures at a car crash.
Am I being too sensitive?
Should we use silent keyboards?
Should doctors all use laptops, so that we can face patients and minimize the computer’s intrusion?
Are doctors just technicians? Is there any art left in modern medicine? How dare we compare medicine to music?
Like every disruptive innovation, computers have brought many good things to clinical care. But they have also corrupted the clinical experience. In some cases computers feel like a fart at a funeral.
We need to incorporate computers into the clinical experience without turning clinical care into a computer experience.
Medicine has definitely changed since I started practice, Shawn, and not always for the better. The fact that it is an art, and not Dr. Google is often lost on our patients. Due to the complexity of medicine, the 15 min consultation, at least in my practice, is a thing of the past. Add to that, computerization, well, even though I type 80+ wpm, I am still doing the job that I used to pay my secretary for. When I set up my new office for computers, I got 24” All-in-ones, that are wall-mounted, that I can swing in and out, and can turn towards the patient to show them pictures, etc. I face the patients all the time, and can look up to them. But it still takes more work per patient, more time, energy and expense to satisfy the CPSO and the MOH. And the disparity between the community docs, who fund this ourselves, vs our academic colleagues, where the hospitals fund it, and the trainees look after entering all the computer stuff, is not lost on me either. Sigh, when I entered medicine, it was to make my patients’ lives better, not to make mine worse.
Wow. Great comment, Connie!
First, I’m impressed with how you’ve computerized and taken the patient experience into mind. But I’m also note your comments about how things have changed. There’s a gap between some of what was good and what is now our reality. Can we get some of that back? Is this just a transition, or is this the new normal? I suspect the latter.
Everyone I’ve ever talked with says that computerization takes more time. All the new quality improvement approaches, clinical tools, graphs and decision support eat up time. Do they improve quality? I think so. I know so in many clinical cases, for me at least. But at what cost? And who bears that cost?
Thanks again for sharing such a thoughtful comment!
Cheers
I agree. Especially for psych patients when the best moments are when I give up typing and just talk face to face.
But if I do that then I miss things in the chart and the college will get mad with my few lines of summary.
Yet, I know the pt realised I was engrossed and focused on everything they said. I will point out things, mention incongruities, probe for details, and yes discuss the suicidality. Too much of the time I am like an automaton, with my two fingered technique staring at the keyboard and correcting spelling mistakes. It becomes an onerous task to get done- my duty. Not my joy. The chart is the science. The interaction is the art.
Brilliant comment, Pat.
And no one pays attention to art, patient service or experience. Sad.
Thanks for taking time to share!
It’s no longer just the way of the future. It’s the way of the present in connecting with patients.