Tuesday, May 5, 2009

Electronic Medical Records Attack Bedside Manners


Physicians and patients are under more strain than ever before. Electronic medical records (EMR) won’t be a force of healing, but will threaten to divide the parties further apart.

We physicians are already under more stress than ever before. We are working harder and earning less. Insurance companies dictate how much (or how little) we are paid and what medicines we may prescribe. We are crushed by an avalanche of absurd paperwork. We worry about being sued even if we haven’t done anything wrong.

Patients are more dissatisfied today also. They often feel rushed through appointments without having adequate time to express their medical concerns. They want more communication and softer bedside manners from their doctors. They want more conversation and fewer medical tests. They complain that medicine has become more of a business than a profession. They admire Dr. House’s diagnostic acumen, but they still want Marcus Welby as their own doctor.

All of these issues strain the doctor-patient relationship.

EMR will only widen the fissure separating doctors and patients. I have heard repeatedly how dissatisfied patients are with EMR technology. In these offices, physicians are interviewing patients hunched over a keyboard as they record their patients’ medical information. Eye contact, a warm smile, a gesture and an understanding nod are not part of the high-tech EMR software. It’s all business now. Understandably, patients have found these impersonal data entry sessions to be sterile and disappointing. Is this technology the antidote for a relationship that needs more attention and healing? I doubt it. It is another ‘advancement’ forced upon us that will come at the expense of something important.

EMR, at least in its current state, will be a force of ‘progress’ that will take the doctor-patient relationship in the wrong direction.

Let’s hope that EMR doesn’t come to mean the End of Medical Rapport.

12 comments:

Janet Mayne said...

I think that the level of satisfaction among patients will depend on the physician who is using EMR. Just because there is a computer in front of them to record the patient's visit doesn't mean that they have to have their noses buried in it. Both my OB-GYN and my daughter's pediatrician use EMR and I don't feel slighted in the least. The physicians speak to me, make eye contact, question, lean back in their chairs and laugh with me and THEN, once they have gotten the overview of why I am in their office, a summary is typed into the computer, prescriptions are printed, labs ordered, etc. While it may be different for me as I have grown up alongside computers, I find it a very efficient process and long overdue.

Michael Kirsch, M.D. said...

Appreciate your thoughtful comments. I hope that when our own office implements EMR, that we have the same experience that you describe. I have heard many patients describe their impersonal EMR visits with physicians who are focused on the keyboard instead of on them. Physicians using electronic record technology need to be very conscious of maintaining personal contact and rapport.

Lynn said...

I actually appreciate EMR. Prior to the use of EMR the doctors would go over my file for about 15 seconds in the hallway before visiting with me. Then come into the room and ask me questions about my health and medication that they should have already known. It felt like every time I visited a Doctor I had to remember and then repeat my entire medical history. Now it seems that we spend less time in review of my health and medications and more time talking about the condition I came in for. And, if by chance my regular Doctor is not available, all of my information is available at the click of a button.

Michael Kirsch, M.D. said...

I hope that our office will have the same experience that you describe. I await the transition to EMR with trepidation and only hope that the anxiety,delays,crashes and expense will be less than we expect. Once it's in place, I will post about our progress from time to time.

Sheetal Dube said...

Your view point is very interesting. Time and again it has been proven that for any technology to be adopted successfully, the value has to be realized by everyone using it. While there is no doubt that EMRs could prove extremely valuable for patients to take more control of their health, it seems that that value is not being felt by the patients. Maybe we need to mindful of the way EMRs are being integrated and ensure that they enhance the patient experience instead of taking away from it.

Anonymous said...

I think EMR is frightening because a patient can be viewed by one physician who may not be perceptive or thorough and his record taking can influence the next doctor not to do what should be done. I have been told that information morphs, but have one doctor be unprofessional with your care, and it can have a major effect down the line while the patient knows nothing as to why things are not being done. This happened to some people and I think it is frightening, as well as a privacy matter that also undermined.

Anonymous said...

Reply to the posting above, yes!

Although I never could figure out how I ended up at the gum specialist office but as a result also ended up with a fake gum disease file. It took a while to sort but the fact is I was sent by his buddy for an exam, odd at the time, and during the gum specialist exam he used a little instrument and sort of sliced my ligaments away from my teeth in some areas. Although I felt a sensation there was no pain or bleeding. He poked back in there one more time and sliced the ligament on a front tooth. I felt it but assumed he was doing whatever he was suppose to be doing for some unexplained reason. After that he took x rays. I noticed later that day the ligament hanging. As time went on I had a problem alright but one that he intentionally created. Appointment after appointment left me dazed and confused until someone pointed at the area and I explained the gum specialist did that during the first visit. For anyone who might not understand, I know now what he did before the x rays was what he needed to prove to insurance that I had gum disease. That is how the ligaments would look. OHhhhhhhh so, my file would show me as a patient presenting with gum disease which I didn't actually have but leaving any other professionals with the same mentality to work that area further. PS The ligaments are composed of a stickly substance on the inside. Alcohol will knit them back to the teeth. Apply a little pressure. Also, vitamin c for the gums. Ohhhhhh All of us working together to survive.

Anonymous said...

Also, some of this I don't understand. Can someone, for whatever purpose, ask a doctor or a worker in an office to tap in on someone's medical records even if the person is not a patient? Does this go by the social security number?

EMR Medical said...

Nowadays many doctors are now taking advantage of the internet to conduct web consultations. we able to access patient data from anywhere in the world via a secure connection even allows the doctor to conduct web consultations or generate reports from home. Health maintenance reminders that can be automatically generated from an EMR system also contribute to providing improved patient care.

emr system said...

Hey there, awesome blog. I really like it.
This is an awesome radiology software program. Check it out!

Radiology Software
Let me know what you think.

Anonymous said...

I found my peditrician knows more of what is going on and does not have to suffle through a paper file to know what my child has been up to. He has at his fingertips all the information. It might seem a little awkward at first, it did for him and us however, now that he and I are getting the hang of it seems to be working quite well. On the other side, my daughters ENT's little thing quit with her while on our post-op visit, it really upset the ENT and she was complaining about the government making them use these. So I can see both sides of the coin. A good Doctor will utlized the resource available to them and work on fixing the things that do not help them with patients. Good luck to all in the medical field. We are in for some major changes regardless. I hope that all medical personel will always remember why they choose their profession and continue on helping people I know I really appreciate my childerns doctors. Keep the wolves out of our care and do what is right at all times. It is not a perfect world but could you imagine how it would be without our "caring" doctors and nurses.

Anonymous said...

Physical therapists plan to send alerts to 1 doctor about therapy related issues on 75 inpatients, and just viewing the alerts automatically acknowledges them, which implies assent unless doctor assesses every patient with an alert. We have over 100 therapists who provide inpatient therapy during the day and the therapists are frequently outsourced to schools outside the hospital in the afternoon. Since the therapists are required to write notes only twice a month, even if they provide daily therapy, it is possible that there is no discussion or information about the alert in a timely manner. Furthermore the doctors receiving alerts are specialist rehab doctors, not the coordinating physicians who round daily on the patients. I would br grateful for thoughts about this.

Add this