nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Friday, April 9, 2010

Is Your Doctor Talking To You Or To A Computer

Electronic medical records (EMR) are posing a challenge to interpersonal communication between patients and doctors.

Many of you have had this experience, right?  You're talking to your doctor while she/he is staring at a computer screen.  You know they're listening to your problem, and thinking about your medical situation, but a part of their attention is on getting the computerized medical record done.

As a doctor in practice, I remember doing this sometimes, but unless you just get mesmerized by the screen, at some point you have to stop, turn around, look your patient in the eye, and give them your full attention.  Some of you may ask, "why do you need to do anything on the computer when you're taking care of me?"

The short answer is, you don't.  The longer answer is, if you don't then you will get behind, because writing up your patient encounter, with all the documentation requirements that are prescribed by law and to protect yourself against lawsuits, AFTER the patient leaves will put you behind and the next patients will wait longer and longer.  In my practice, I had to see 22 patients a day.  Given that I had to eat lunch sometime (and sometimes I didn't get to it), this gave me about 15-20 minutes per patient.  So, the best doctors try to make the electronic record process as unobtrusive as possible, but stay on track.  In the worst cases, patients feel invisible, not receiving their doctor's full attention.  Bottom line, to manage it all well is an art.

But, The Center For Studying Health System Change published a brief on electronic records and patient communications, subtitled "Are We Talking Less?",  that addresses these issues:  electronic records both "enhance and disrupt" the patient encounter. 

They describe other pitfalls of EMR:  thinking the computer will tell you all you need to know,  and reducing the communication between doctors that's essential to coordinate care.

There are unintended consequences to every policy decision.  Electronic Medical Records can be a good tool for improving quality, but they can also disrupt the "human" dimension of taking care of people.

It's clear there are issues to work out as we implement an automated system throughout healthcare.  It's important to recognize that we are not pursuing "quality" for its own sake, but as a tool to reach the real goal:  giving the best medical care to every patient.

I used to joke about how the advent of scientific health care management had changed my life:  in 1975 I was a doctor, taking care of patients.  Now, I'm a health care provider offering services to eligible beneficiaries

Have we lost something along the way?


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