It is time to consider a blend of paper and electronic records. Paper records will not remain relevant forever, nor will electronic records remain infallible. The purpose of any record is to ensure that the past is preserved. If the past is lost, the present feels weakened. However, this sense of weakness arises only when the present constantly relies on the past. What if there were no past to refer to, allowing the present to create its own future? It would then be up to the future to decide whether to keep a record of the present as its past.
All of this is easier said than done when managing patients. Should we focus on their chief complaints or their past medical history? How do we manage patients without any record of their past? While we might not perform at our absolute best, we can still provide appropriate and adequate care. If we don’t see recorded allergies, we ask the patient. If they don’t know or can’t tell us, we rely on best practices and clinical judgment. The same applies to medications; if there are no records, we ask the patient and proceed with our best practices and clinical judgment.
May the vulnerable digital world allow our humanity to revive through direct communication, enabling us to connect using our human head, hand, and heart. Instead of relying on artificial intelligence to guide us, we should trust in our human hearts, which, despite setbacks and mistakes, rise again with resilience. Unlike artificially intelligent systems that may be more easily corrupted, our human spirit endures, as our hands make errors, our minds acknowledge them, and our hearts forgive.
Interestingly, those who missed the shift to electronic records might rejoice at the revival of paper recordkeeping. Concise and relevant paper records can be more informative and less likely to omit critical information for immediate patient care compared to the often overwhelming and redundant electronic records. This is true as long as paper records are legible to humans and scannable by artificial intelligence. Who knows? In the future, artificial intelligence could automatically update and summarize cumulative paper and electronic histories for easier reference and use.
Ironically, overdiagnosis and overtreatment in stable patients with no immediate symptoms, only chronic diagnoses in their history, and incidental findings during current encounters may have led providers to overlook relevant findings for immediate care. Should we be concerned about patient safety in the absence of electronic records? Patients were managed with paper records before we became overly reliant on readily available digital information, leaving us seemingly helpless without electronic records. Haven’t we managed John and Jane Does, who couldn’t communicate their histories, while our patients could at least verbalize their records to guide immediate care, even without paper or electronic records? Educated patients often keep and update their personal records, which could be invaluable in the absence of electronic records. Would regular drills testing electronic blackouts or downtimes prepare providers and patients for any eventuality? Interestingly, we might need to relearn our handwriting skills, which were already difficult to read in the past and are likely worse now, given that typing often outpaces our ability to write legibly.
Essentially, during electronic blackouts or downtimes, skilled providers and educated patients can still manage immediate complaints effectively, relying on their expertise despite the absence of limitless artificial intelligence resources. While excessive information is crucial for research and quality metrics, it may not be as vital for immediate patient care. This is true unless we, as providers, have become overly dependent on electronic records, hindered by constant concerns about non-payment from payers and threats of liability from litigators.
Who knows if Detective Inspector William Edward “Jack” Frost’s intuition in A Touch of Frost and Special Agent Leroy Jethro Gibbs’s gut instinct in NCIS might be revived to keep us as human as possible for as long as possible? Such a revival could remind us that we can indeed exist without artificial intelligence. This isn’t retrogression, but rather progression within the cyclical nature of life, where everything that goes around comes around.
Deepak Gupta is an anesthesiologist. Sarwan Kumar is an internal medicine physician.
