This appeared late last week.
Turn Off the Computer and Listen to the Patient
The practice of medicine is a subtle art. Doctors need to give patients their undivided attention.
By Caleb Gardner and John Levinson
Sept. 21, 2016 6:50 p.m. ET
Of the many problems facing modern medicine, the deterioration of the patient-doctor relationship is one of the most pernicious. Today our health-care system is losing its humanity amid increasingly automated and computer-driven interactions between doctors and patients.
The signs and symptoms of this pathology are everywhere and have been described in these pages: Primary-care appointments are now as short as five minutes, and the physician must spend much of that time typing instead of attending to the patient and performing a physical examination. Medical students and residents are spending more time with screens than with patients. A 2013 study from Johns Hopkins showed that first-year physicians spent a meager eight minutes a day with each of their hospitalized patients while spending hours at the keyboard describing and quantifying those fleeting moments. Meanwhile, fewer doctors would like to see their children enter a career in medicine, and escalating health-care costs are crippling families and the economy without improving public health.
The electronic health record (EHR), once a promising new medical technology, is a major cause of this disconnect. Not long ago, doctors dreamed of a time when unwieldy paper charts would be replaced by streamlined computer systems, freeing them up for more direct patient care. But now these computer systems are distracting and burdensome. Senior physicians are retiring early because of the EHR, while young doctors feel the humanity draining from a profession to which many were drawn because of a desire to interact and connect with people.
How did we get here? One cause is the development of third-party health-care financing, which grew out of the Great Depression and eventually led to the ascendance of insurance corporations with the ability to influence the clinical practice of hospitals. Similar economic forces have decimated private medical practice, as physicians become employees of hospitals and larger hospital systems. Medicine has become corporatized.
In 2009, with this stage set, Congress passed the Health Information Technology for Economic and Clinical Health (Hitech) Act. The act was designed to improve the U.S. health-care system by promoting and standardizing the use of computer technology by physicians. It prescribed, in great detail, a set of federal standardized instructions for how doctors must use computers in medical practice, such as what data to collect from patients. It also provides a mechanism by which hospital systems can prompt doctors to make decisions that are more in line with the hospital goals and practices. These instructions, enforced by financial incentives, are collectively called “meaningful use.”
Computer programs and one-size-fits-all rules for medical practice have thus become central to the care process. Through the EHR, a physician is pushed to start a “preferred” medication, or not to order a test that the computer program deems unnecessary. The system forces doctors to choose from a set of tens of thousands of billable diagnosis codes before making any clinical decision, no matter how nuanced the individual case and circumstances may be.
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Dr. Gardner is a physician and resident at Cambridge Hospital in Massachusetts. Dr. Levinson is a cardiologist at Massachusetts General Hospital and Harvard Medical School.
The full article is here (subscription required):
Reading this I could not help thinking of the ePIP program and wondering just what of impact the pressure to be filling in and transmitting Shared Health Summaries was having on the attention being paid to patients.
It would be sad if what we see is a reduction in the quality and focus of care on the patient while doctors work to offset the draconian and pernicious freezing of GP rebates by spending extra time at their computer screens.
There is no evidence, or even planned research, I know of regarding the impact of extra, essentially forced screen time on patient care. Another unintended consequence – who knows but it is possible.
As always it is important to remind ourselves that the ePIP expenditure would not be required if the myHR was genuinely useful for GPs and this that this fact stimulated usage, rather than financial pressure.
David.
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