Do you believe that I have to mention this? I can’t believe it either but since the advent of the EMR, this seems to be an issue; a really big issue. Amazingly enough, you are there, as a doctor, to treat the patient and not the computer. You would think it was the other way around with all the bogus quality indicators, meaningful use baloney and pay-for-performance nonsense being stuffed down our throats, but don’t let those who are now in charge of healthcare fool you. It really is about the patients.
I am on my third EMR system but I never let the computer enter the room with me. In other words, I preview the chart and then go in naked. Ok, I wear a stethoscope but that is it. Why? Because I want to look the person in the eye. Yes, you read that right, look at the patient.
Human beings are interesting animals. They kind of like to interact with other humans, which includes their doctor. Staring at the computer screen interferes with that. Patients want to feel important. They want to feel listened to. When you look at the patient, you acknowledge that. You also listen better. When you turn to the EMR screen, you don’t. You may try to listen to them, but you are obviously searching the chart or typing in some information or prescribing a drug and guess what the patient is doing? He is either still talking or he is getting his own thoughts interrupted. This is not good care no matter how you rationalize it.
Maybe you are better than I am. Maybe you can bring your laptop into the room and really isolate the interview part of the visit by truly listening fully to the patient and not turning to the EMR, who, by the way, is screaming at you inside his or her head, “Look at me!”
If you can pull this off then good for you. It does not work for me. Most of you, however, are like me and will succumb to the temptation of turning to the damn computer too early. Sure, you will promise yourself you won’t. You will fight the pull as hard as you can and maybe you will succeed for the first few patients of the day. Unfortunately, your willpower will weaken and you will start cheating. Trust me, once that happens there is no going back for anyone else on your schedule. Been there, done that. Listen to me, don’t take the damn EMR into your room. If it is already there, shut it off.
Yes, we all need EMRs. Yes, with my way of not bringing the EMR into the room makes me leave at times to check on things but it also allows me space to think, time to look up stuff that I don’t know, and also stops the patient from interrupting me with more complaints that just popped into his or her head.
Lastly, if you would ask an old-time doctor whether looking at the patient was difficult to him then he would probably answer no and wonder whether you were an idiot. And he would do this the whole time while … looking at you.
Doug Farrago is a family physician who blogs at Authentic Medicine.
