As many of you know, much of my focus has been on how we can improve health care information technology, and build on the systems that we currently have to make them more user-friendly and less cumbersome. At the crux of the problem is the issue of the disproportionate amount of time they take to navigate and how they turn the noble and personable art of being a doctor, into some type of data-entry clerk and box-ticking exercise.
Central to this concern is the question of what being a physician should really be about — and by extension — the very nature of health care itself (the doctor-patient interaction being at the center of all health care delivery). A couple of weeks ago, I wrote about how in health care, communication is everything. Here are three ways that information technology currently impedes good communication:
1. The doctor who is glued to their computer screen. One of the biggest complaints I hear from patients is how their doctor hardly looks at them in the eye anymore during office visits. Patients want nothing more than a good face-to-face talk with their physician (and whatever the future holds, at least for the next 30 years or so, we will still be dealing with that generation who wants and values good old-fashioned direct communication!). From the doctor’s perspective, what used to be a quick 2-minute note, has turned into monstrous, endless rows of tick boxes that need to be filled out for every patient. I have devised my own techniques as a hospital doctor for getting away from the computer and staying true to the ideals of good medicine.
2. Assuming that what we see in the computer is 100 percent accurate. I have been in countless situations where patients have informed me, irritated, that what’s in the computer is wrong, and keeps carelessly being copied over again and again. In the past, for example, the physician would simply confirm by just asking the patient what medications they were on. Now we tend to bypass this, and just blindly trust what’s in the computer. At best, this takes a few minutes to rectify. At worst, it’s a safety issue. A common scenario is the patient who complains to me that as they go through the hospital, doctors just keep “believing” the computer medication list, and despite them continuously requesting to update it — it never is! Every doctor has probably seen a situation like this.
3. Physicians talking to each other. Previously, physicians would interact much more with each other in the hospital. Whether it was on the floors, or the small amount of free time they had to sit in the doctors’ lounge, cases would be discussed and treatment decisions shared. Instead, when doctors do now get each others’ opinions, it’s only the digital footprint that’s on the computer. This exacerbates “Too Many Cooks in the Kitchen Syndrome.” Medicine often has more grey than black and white, and it’s so important that collegial interactions and discussions are still happening on a daily basis.
The above are just three examples of what excessive and cumbersome information technology has done to health care. This is not to lessen or belittle the amazing advantages that technology has also brought, including the ability to rapidly search and retrieve information (remember those bad old days of piles of charts and illegible handwriting?). But we need to remember that health care is above all else, a human profession — where personal contact and communication must be maintained, valued and promoted.
Suneel Dhand is an internal medicine physician and author of three books, including Thomas Jefferson: Lessons from a Secret Buddha. He is the founder and director, HealthITImprove, and blogs at his self-titled site, DocThinx.
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