From a medical provider’s perspective, interacting with patients used to be easy. You went in to the room, shook hands, had a conversation, did a physical exam, discussed the patient’s condition, wrote a few lines in the paper chart about your findings, wrote a prescription or ordered some tests, shook hands and said good-bye. When you left the room, everything was documented in the paper chart. The provider was convinced that the communication with the patient had been thorough, accurate, and satisfying. Most often, the patient would have agreed.
But now, something new is in the exam room — the computer. This computer, which holds within it the electronic medical record, represents progress. Your record is legible; the prescriptions it creates are legible and hence safer. Not only that, but it has all of your tests, lab results, and other documents available at the click of a finger. Everything about your care is better documented.
However, although the Electronic Medical Record (EMR) may be good for documentation and for patient safety, it is often a hindrance to good person-to-person communication: the patient often leaves feeling like an object. Patients want eye contact, dialogue, a sense of connection, and their questions answered. They deserve these things. Unfortunately, in the age of new technology, we have too often lost the personal connection and familiarity that should take place between a patient and the provider with whom they share anything and everything.
For many people, the doctor-patient relationship isn’t working anymore, not only because the computer is an obtrusive third person in the room, but also because medical providers have to enter so much more information than they did in the past. Insurance companies, government agencies, and quality-measurement organizations are all requiring documentation. This documentation is very important and has vastly improved with the EMR.
But what has been the cost? If your provider does not enter information in the computer during your visit, he will have to do it at night, on a day off, or on the weekend to keep up. In order to get the work done, the majority of the time spent by the provider is with the computer rather than the patient. The patient often feels as if he is no longer a participant but an observer in the process. It is as if he is outside the room watching the encounter with the provider.
What can we do about this? The EMR is here to stay. To help prevent the loss of personal contact and interaction, we need to recognize that the electronic medical record is just a tool. We have to find a way to work with it. We need to make sure it doesn’t ruin the quality of our medical visits.
So, here are some tidbits that providers and patients can use:
1) When your provider comes into the room: greet them, shake their hand, and let them know up front the concerns you want addressed during the visit. If you wish to give them a list of your concerns and questions, do this at the beginning of the visit.
2) If your provider goes directly to the computer and starts typing and asking you questions without looking at you, ask him or her politely to stop dealing with the computer and talk to you for a minute, face to face. Doing this might seem very difficult. To make it easier, you could say something like, “I know it is really important that you make accurate notes of the details of my case so ask me what you need to know, but I do want to talk to you face to face before we are done.”
3) Help your provider with the information entry process. If you are a new patient, they would appre-ciate old records that contain lists of your diagnoses, hospital procedures and operations. For all pa-tients, an up to date, accurate list of your medications (as you are actually taking them and not as they were originally prescribed!), can be a big help.
4) As your provider inputs the data, ask if you can watch. You may see that he or she misunderstood and entered something incorrectly; you can let them know that. You both want to be sure that your chart is accurate. Ask to see some of the information the computer is good at producing such as your child’s growth curve or reviewing the trend of your blood pressure, weight, cholesterol level or your hemoglo-bin A1C level (a measure of your blood sugar control if you have diabetes). If they don’t know how to do these things, they will soon learn!
5) Once the data has been entered, you and your provider can spend some time face to face when your specific concerns can be addressed and your questions answered. If the provider says she doesn’t have time for that, you must politely express your dissatisfaction (after all who is paying for this?!!) and let her know your goals for the visit have not been met. This will usually get you the time you need.
6) As the visit comes to a close be sure to thank your provider for her time and give her a warm hand-shake. An expression of appreciation goes a long way and often times your doctor will remember you and the details of your case even more clearly the next time you come in for a visit.
Dr. Robert P. Allen is the executive medical director of Penobscot Community Health Care in Bangor.