emergency medicine

Two Patients

Right now there are two patients in every room. One is made with flesh, bones, and blood. One is made with a monitor, a mouse, and a keyboard.

Both demand my time.

Both demand my concentration.

A little over two weeks ago I wrote the short story Please Choose One. I posted it online. The response it generated exceeded anything I could have ever imagined. It struck a nerve. People contacted me from all over the world, from all walks of life, about the story. Everyone, it seems, can relate to the challenge of having to choose between a person and a screen.

People sent me all kinds of suggestions and ideas. A few sent words of encouragement. Yet, what struck me the most about the people who contacted me was what they did not say. Not a single IT person argued the computer was more important than the patient. Not a single healthcare provider stated they wanted more time with the screen and less time with the patient. And finally, most importantly, not a single patient wrote me and said they wished their doctor or nurse spent more time typing and less time listening.

Medicine is the art of the subtle- the resentful glance from the mother of the newborn presenting with the suspicious bruise, the solitary bead of sweat running down the temple of the fifty three year old truck driver complaining of reflux, the slight flush on the face of the teenage girl when asked if she is having thoughts of hurting herself. These things matter. And these same things are missed when our eyes are on the screen instead of the patient.

I get it. We need to collect the data on patients. In the modern world, medicine is also a business- a business of collecting, sorting, and collating data for billing purposes. I am not naïve enough to believe or argue otherwise. But maybe right now we need to step back and ask ourselves the one question no one seems to want to ask:

Has the data we store about the patients somehow become more important than the actual flesh and blood patients themselves?

One of the most difficult things to do in the practice of medicine is to recognize when a previously established diagnosis is incorrect. It requires having an open mind that maybe, just maybe, the prior five doctors have been wrong. I wonder if we are at a similar point. Maybe we do not need another screen in the room, another page of data, another flag popping up on the screen warning us to address some incomplete part of the patient’s record. Maybe instead, we just need to spend those thirty seconds interacting with our patients.

Computers, EMRs, and patient databases are ultimately a good thing. We need them. I have no doubt that we will reach the point when they can collect all the data they need without inserting themselves between the doctor and the patient. But we are not there yet.

To the IT people out there who were offended by the story, my message to you is clear. You are the very ones who can help save us. Keep working, keep innovating, keep looking for ways to build a better, more invisible system that still does what it needs to do. After hearing from so many concerned people in the IT industry, I have nothing but faith we will find our way together. Ultimately I am reminded that we all want the same thing: to do what is best for the patient.

I am looking forward to the day when I step into a room and there are two providers. One made with flesh, bones, and blood. One made with a monitor, a mouse, and a keyboard.

Both advocates for the patient.

©Philip Allen Green

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8 Replies

  1. Once again, there is a very simple answer to all of this. Get a scribe.
    They are young, educated and motivated individuals who are looking to learn anything and everything from you. Many of them will do almost anything to make your life easier.

    More technically, with a scribe, the only reason you will need to be on the computer is looking over patient history, signing orders already entered by the scribe and looking over the scribe’s documentation.

    • A scribe only solves the problem of putting the information into the computer. It will not stop all of the silly questions doctors have to ask in order to satisfy endless “quality” measures. (In the Choose One story, would a scribe have helped by reminding the doctor to ask his patient if she smoked or wants tobacco cessation counseling?)

      It will also not help squeeze the patient’s story into convenient structured data entries. (Will the scribe remind the doctor to be sure to say out loud whether the patient is distraught, calm, or agitated? Or will the scribe use their clinical judgement to check off that box?)

      I don’t see the problem as solely one of getting the information into the database, as much as I question why the database is there to begin with in a format that does not improve patient care.

    • The problem with a scribe is someone has to be willing to pay them. Unless the physicians are paying for them out of their own pockets, I guarantee they won’t have one. No hospital is going to pay for that. And what about other healthcare providers? As a nurse, I probably spend at least four to five hours out of every shift at the computer, and paying a scribe minimum wage would cost me 1/3 of my salary.

  2. But computers are going to take all of the doctors’ jobs, right? They diagnose cancer so much better than humans. Doctors are on the way out! Bow before your computer overlords!

    Such is the sentiment of many but doctors and patients. The human element is what people crave most when they are ill. Doctors ignore this to their peril. Systems need to be designed around this.

  3. Yes! Get a scribe!
    I currently work for PhysAssist Scribes and love love love my job! Most of us are pre-med or pre-nursing students.
    The ED physicians I work with love getting to spend more time with their patients, and sometimes we catch things that they didn’t hear or even notice. It’s also a great learning experience for us!

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