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Got Rockwell? Don’t Create a Scene Not Worth Painting

April 30, 2013
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Norman Rockwell liked to paint everyday American life and the images he painted are incredible and iconic. Rosie the Riveter, “Freedom from Want,” the paintings of World War 2 and the civil rights struggle, the baseball umpires—the guy died eight years before I was born and I know most of them off the top of my head.

Hell, if you don’t have one in your house, you probably know someone who does. His paintings, for me, are as much of a visual representation of the 1940s-60s as any movie or TV show from that same era.

Why am I bringing up Norman Rockwell? Because I often wonder what Rockwell would have thought of America today. How would he paint everyday life in the year 2013? As one comedy writer, Tim Siedell, opined on Twitter a few years ago, we might have seen a lot of paintings where people (including yours truly) have their heads down and eyes looking firmly at their smartphone.

What about in healthcare? How would this Rockwell classic—an attentive, caring doctor taking the pulse of a sad little girl’s doll—translate into today? Healthcare has changed, and if the results of a recent study from the Journal of Internal Medicine are an indication, that image would look a little different. Rockwell might have painted a young doctor staring at a computer screen, while the little girl and her doll wait in another room or at the bedside.  

Doesn’t have the same heartwarming effect, does it?

The study’s authors, led by Lauren Block, M.D, M.P.H, clinical fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, looked at clinical interns at large academic medical centers in the Baltimore area last year. In total, the researchers observed interns for 873 hours. They wanted to see how much time was spent in direct patient care, i.e. interacting and examining the patient.

What they found was that, a whopping 40 percent of the time, interns were staring at a computer. In contrast, the researchers say their interns spent 12 percent of their time, total, in direct patient care. Fifteen percent was spent with educational activities and 9 percent was spent doing miscellaneous activities.

As the study’s authors noted, interns are “wrestling” with the “effects of electronic medical records and the documentation needs and availability of an ever-increasing amount of stored patient data.” This patient data seems to have taken away from interaction with the patient. Leonard Feldman, M.D., the study’s senior author and a hospitalist at The Johns Hopkins Hospital (JHH), is a little blunter about this reality in a press release on the study.

“Most of us went into medicine because we love spending time with the patients. Our systems have squeezed this out of medical training,” Dr. Feldman said in a statement.  The hospitalist also questions openly whether the little time interns spend with patients today is enough to give them the experience needed to practice excellent medicine.

While systems might seem like the problem, the authors actually say EMRs could be created to help reduce time spent “combing through patient histories on the computer.” Thus far, it’s unclear if EMRs have been created to do that. You can’t dismiss the importance of data, and what it could mean to improving outcomes and lowering costs. These systems are the new reality, whether some would like to admit it or not, and that’s a good thing.

However, I do understand the point Feldman, Block, and the others are trying to make.  “All of us think that interns spend too much time behind the computer. Maybe that’s time well spent because of all of the important information found there, but I think we can do better,” Feldman added.

As systems become more ingrained in doctors’ workflow, and as a new generation of practitioners accept them as a reality of the business, it’s important to not lose sight of the importance of direct patient interaction. A nice balance is not too much to ask, is it?

Let’s not force the future Rockwells of America to paint a less-than-engaged portrait of physicians in the 21st century.