I was constantly sick as a child with ear infections, meaning I was in the doctor’s office all of the time. However, about the time I turned 3 years old, I got Bell’s palsy. My mom is a nurse and did not often overreact to medical issues, but she was obviously terrified of my drooping face and rushed me into the doctor’s office. Given my previous history of visits for my ear infections, the doctor was somewhat impatient. Assuming I was there for another ear infection, he walked into the room while looking at my chart, never looking up. As he was prattling on about how we were in the office far too often my mom looked at him and yelled, “Just look at her!” The moment he did, his jaw dropped and he rushed into action.
I don’t remember this at all, but it clearly affected my mom. We soon switched doctors, and my mom retold that story often throughout my childhood.
Whenever I was asked if I would take notes on the computer while in the room with a patient to save time, my gut reaction was no, absolutely not: the patient should come first and my attention needs to be on them at all times. More recently, I have had the opportunity to actually experience what being in the real world of medicine is like for a doctor, and it is far different from what any medical school class makes it out to be.
My school prides itself on its ability to turn its students into professionals that are able to talk to patients. In fact, as first-year medical students we have a class dedicated to simply learning what questions to ask and how to ask them, so that by the time third year arrives we are prepared to step into the role of “competent medical student.”
However, the real world of medicine does not allow for doctors to be able to ask all of the questions we learn in medical school and take all of the time that is necessary with a patient. There is just far too much to do — doctors need to talk to the patients, figure out the story, do a physical exam, determine differentials, order tests and medications and chart on the patient using a computer system that is not intuitive and takes far too long to operate. This is all incredibly time-consuming. Any way that doctors can save time can and should be used. But this comes at a cost — less and less time is being spent with the patient.
Despite the fact that the doctor is spending brainpower dedicated toward the patient, their focus is not actually on the patient. They may be thinking about differentials and ordering tests, but there is a disconnect between the provider and the patient.
I’ve seen it firsthand. Whenever I have been in the room with a patient while the doctor was on the computer, there were large gaps in conversation and many times when we were all sitting in silence. Often these awkward moments had nothing to do with the doctor’s conversational skills — she could have been the most personable doctor alive and these moments still occurred. It’s hard to have a conversation when one person is distracted by a computer.
Nevertheless, it’s a little harsh to place all of the blame on the recent introduction of computer charting. Still, ever since technology has taken over in medicine, there has been a distance growing between doctors and their patients.
For instance, my mom used to love to tell me about a prank one doctor would pull on his colleagues during the night shift change in the emergency department in the ’90s. Basically, he would go into an empty room, put a Halloween mask on and hide under the blankets. He would then start shaking the monitor cords so the monitor’s signals would be all out of whack. The nurses would rush to the incoming doctor and say, “Something is wrong with this patient and we can’t find the other doctor! We need you in the room!” More often than not, he would race into the room, stare at the monitors and start barking out orders. Only after he did this would he actually look beneath the covers and find the doctor with the mask on. It was intended as a joke on the other doctors, but also taught them a valuable lesson: the moment you walk in that door you should look at your patient. Computers and monitors are great, but they don’t give you the whole picture — the patient does.
Spending all this time focusing on the patient is idealistic, but it’s hard to say if it is realistic. The real world is far from perfect, and doctors are only human. There is no doubt that using a computer saves time that can be spent doing other and better things. But doctors have to be cognizant of not letting technology affect their care of the patient.
So, what’s the first thing you do when you walk into a patient’s room?