Sunday, September 2, 2012

Computers in Patient Care

I’d like to start this blog with a comment that I am a strong proponent of using emerging technologies to help improve patient care.  I believe in the power of mobile computers to help us with patient care.  I believe that we should use technology to augment the care we provide, not replace it.  However, I had an interesting hallway conversation with one of my fellow attendings earlier this week, which caused me to reflect on this topic, and ultimately write this.
Electronic medical records are touted to help improve efficiency, to be able to collect information to help us improve the care we provide, as well as other positives that are well-described.  The government is even providing incentives to health care systems and physician practices for “Meaningful Use”.  I have believed in the power of computerized physician order entry, or CPOE, for a while, having had it at one of our training hospitals when I was training in 1994 – 1998.
However, the discussion I had the other day made me really think.  Trainees (and attendings, as well; we are not any different) spend so much of their day on the computer, and this appears to be coming at the expense of face-to-face time with the patients.  This article suggests that direct time with patients is not ideal for residents on call, and that much of the time on call is spent in front of a computer.  12% of the time was spent in direct patient care.  12%!  I am concerned about this, and I bet patients would also have similar concerns.
This article, with a drawing by a child highlighting what they see with regards to doctors and computers, pretty much sums it up: even children are noticing that doctors are “tethered” to the computer.  This has to change! 
I do believe that we can fix this.  It starts with acknowledging this “elephant in the room” (or, more aptly, the “computer in the room”).  I am currently spending a few weeks on the inpatient service at our county hospital, and had the chance to discuss this with our medical students.  We made sure that rounds on patients including going to see the patients and interact at the bedside, not just exclusively sitting around a table discussing the patients.  We discussed motivational interviewing (and demonstrated it) and getting to know patients as people.  We reflected on why all of the students went into medicine, and none said “to type information into a computer.” “Stop and smell the roses” was the take-home message of the day, the roses being, among other things, time with patients.
Please, please make sure that staring into a screen doesn’t replace sitting at a patient’s bedside.  Please make sure to talk to your patients, to look them in the eye, to ask them what they think, and to answer their questions.  It will help the patients, and it will promote the humanism that is at the heart of the patient-physician relationship.  Yes, computers and mobile tablets can help us care for patients, but in my opinion, there is a bond between a patient and a physician which should never be replaced by a computer.  Let’s not break that bond!


  1. Well said. I think part of it has to be a culture change in some ways away from the drive towards efficiency at all cost, I have one colleague who was chastised by a preceptor for speaking to a patient for too long. While there needs to be reasonable limits, I can't help but think that in some ways the efficiency mindset has detracted from the art of medicine and our vocation as healers.

  2. In my medical humanities class this semester, we discussed possible problems with the doctor-patient relationship, but never did we go into something like this! How interesting! Actually, this could be said of all kinds of professions, for example, in business meetings, if employees are spending too much time writing on their computers or checking email instead of listening to the speaker. Doctors should be aware that they are not necessarily immune from this. I think another problem with technology may be that if the electronic files are lost, there is no way to get them back. Maybe a combination of computers with old-fashioned paper files is best?