EMR, a patient's perspective

My oncologist’s office implemented a new EMR system when I was in the middle of chemo. Once the nurses learned the system, I saw no difference in the care I got from them.

Not quite so with the doctor. My experience with him changed dramatically.

Before EMR I would enter the exam room and sit on a chair, play Angry Birds on my iPhone and wait. My doctor would walk in, make eye-contact and ask me how I was doing. Then he’d sit down and face me, my chart on his lap. I would put away my phone and describe any concerns I had while I admired the oddball tie he was wearing that day. He would answer while actually looking at me, occasionally glancing down to jot notes. There was a human connection there, albeit on a professional level. We had a conversation. He’d ask a question and my response would bring up another question, or I’d remember a concern and go from there. We looked at each other. He was in control, but there was give and take. I’d leave the office feeling like my concerns had been addressed and my needs as a patient met.

After EMR the experience changed. I now go into the exam room and sit on a chair, play Angry Birds on my iPhone and wait. He walks in, makes eye-contact, asks me how I’m doing, and then turns to sit in front of the computer – with his back to me. My doctor, with his penchant for humorous ties, could be wearing a dead pig around his neck and I wouldn’t know. I hear the mouse go “click click click,” then he asks a question. I answer and then “click click click … type type type type.”

Since I don’t want to interrupt his train of thought while he is typing and clicking through various screens, I go back to playing Angry Birds. When he’s done with what he’s doing, he asks another question. I answer, and the whole thing repeats. Because each question/answer/typing session takes so long, I continue to play my game while he works. This goes on for some minutes, and any human interaction or spontaneity is gone. It’s a very stilted experience. I’m playing a game and he’s deep in his computer.

Kind of like my family after dinner.

Because I saw him before EMR was implemented, because at that time I learned he’s caring and competent and responsive to his patients, I don’t feel slighted or that he’s displaying a lack of interest. I feel comfortable enough so that if I did have a great concern, I would express it even with his back turned, and I feel confident he would drop the mouse and face me. However, had this been my first exposure to him – had his back been turned to me during the early days of my cancer diagnosis, when I was facing the unknown, I might very well have turned my back as well – right out the door to another physician.

I understand the need for documentation, and am a big fan of technology. I was rooting for Watson, not Jennings. I also understand that many exam rooms are not set up so that a doctor can face a computer and a patient at the same time, which is the case with my doctor. I am guessing that many doctors are not experts at typing and it takes a while to input their notes, time which leaves a patient twiddling their fingers. Some systems may very well be badly designed, with too many screens to go through, interfering with the interaction.

However, these are things that need to be worked out before fully implementing an EMR system, at least for any doctor who cares about making a human connection with a patient. There are tablets, iPads, laptops. There has to be a way to maintain a bedside manner method of doctoring while embracing the digital age.

So much of being a good doctor, from a patient’s perspective, is not only medical knowledge, which (rightly or wrongly) we typically take for granted, but also the ability to relate to us, to look at us and see if our truths are being expressed. Trust is essential – after all, the physician is about to cut us open, amputate a body part, radiate us, poison us with chemicals, tell us if we are going to live or die. We need to know that this doctor is a person who will treat us with dignity, who will do the best professional job for us he is capable of. We need to know he takes our concerns and fears seriously. We want him to want us to live.

It’s very hard to gain that kind of information and learn to trust somebody with our well-being and our lives when all we see and hear is the back of a white coat and the click of a mouse.

EMR may be the future of medical management, but it hopefully won’t come at the expense of a true doctor/patient relationship, which we patients really do need. While I admit I was rooting for Watson to win Jeopardy, the truth of the matter is, I’d much rather have Ken Jennings as my doctor.

Ann Silberman is a breast cancer patient who blogs at But Doctor… I Hate Pink.