The Doctor Won’t See You Now

Is a computer coming between you and your doctor? In clinic, I’ve been on both sides of the screen – and the view isn’t pretty from either perspective.

For many patients, doctor visits can seem more like a transaction with an airline ticket agent than a personal conversation about your health. A major culprit is the electronic medical record, the bits and bytes that are the digital you-at least the medical version.

A  new study sheds a revealing light on just how much time doctors spend interacting with patients vs machines. Spoiler alert: the machines are rapidly gaining ground.

A time-motion study was conducted of 57 doctors observed for 400 hours in medical clinics. Of the time in the examination room, 53% was devoted to direct face-to-face conversation with the patient and 37% was face-to-screen time with the electronic medical record. The remaining time was involved with administrative and other tasks.

In other words a 15 minute return visit yields roughly 8 minutes for conversation. No wonder why both patients and docs are frustrated.

How did the electronic health record become so all consuming? The first reason is that a whole lot of data needs to be entered: for reimbursement, for regulatory compliance, for hospital policy, and, oh yes, for patient care. Secondly, the process of entering data is often far from intuitive. That’s why most physicians report spending much more time entering data into the digital record than was required with the old school paper and pen system. Seems kind of counter-intuitive doesn’t it? Technology slowing us down.

The result is that patients don’t feel listed to, especially because it is disconcerting to be speaking to a physician whose gaze is directed at a computer screen.

Doctors aren’t happy about it either. I can’t think of a one whose dream of a career in medicine included honing their typing (I mean keyboarding) skills. Had I known, I would have taken my 8th grade typing class much more seriously. Most physicians desperately want to spend more face to face time with patients. In fact, lack of time spent with patients is a major source of physician discontent, and a leading reason for career changes.

Despite the problems, not many want to return to paper charts. I remember well my days as a medical student and intern running down to the hospital basement to find the cavernous medical records room, only to search for my patient’s records among huge piles of overstuffed charts. Sometimes they couldn’t be found. And when they were, the chicken scratch notes were often illegible.

The introduction of the electronic medical record has streamlined the exchange of medical information-but only to an extent. Exchanging clinic notes between doctors in the same medical system is now often seamless.

But try moving your information to a doctor in another medical center, one that may use a different electronic record, and the process becomes much more cumbersome-one that often requires resorting to printing out paper. Think 1980. There are initiatives underway to assure a more widely accessible exchange of digital health information, but there is a long way to go to achieve that goal.

The electronic health record is a relatively new technology, and there is an urgent need to make it easier and more intuitive for doctors to use. The sheer volume of data entry required also has to be reduced.

Although seemingly issues of importance only to doctors, the logistics of the electronic record strongly impact the patient experience and, perhaps, even the quality of care.

My Suggestions to Minimize Electronic Interference During Your Appointments:

-Be as organized for each clinic visit as possible, prepared with written concerns, requests, and medications. This makes for a more efficient use of time, and quicker input of required information.

-If you feel you are playing second fiddle to the computer during an exam, I urge you to explicitly discuss the issue with your doctor. Maybe asking for even a few minutes of direct conversation without the involvement of a computer. I believe the outcome will be especially favorable if you also acknowledge that you appreciate the doctor’s time constraints and pressures.

It’s time that we all talk more about the electronic elephant in the room-and work together to make it smaller.



Allocation of Physician Time in Ambulatory Practice

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