Recently, I participated in medical grand rounds at several hospitals. The primary topics of all these grand rounds were focused on delivering better care. One of these sessions was presented by Dr. Margaret Cary at Georgetown University Hospital on the topic of coaching, the role of active listening, and asking phenomenally good questions. These behaviors result in tremendous improvements in effectiveness for doctors, as well as improved satisfaction for everyone they deal with, patients, peers and staff alike! Dr Cary wrote a terrific essay on the value of presence here. My previous blog on this subject is here.
During the course of one of the exercises, I shared in a private one-on-one discussion that my career involved helping use HIT to improve the quality of care. I pointed out that, prior to the establishment of "meaningful use," the rate at which healthcare encounters including adequate documentation of the patient's current medications and problems was very low. Clearly, not concordant with anyone's definition of quality. And, furthermore, how can a patient be satisfied with their providers if those providers don’t reliably know the patient’s story and concerns?
A very experienced, talented physician pushed back on my point. For him, the use of any form of IT in the exam room always decreased the extent to which the physician expressed care to the patient. The use of computers decreased or eliminated eye contact. Computers, according to the doc, took the physician's focus away from patients and their needs, and moved it to the needs of completing some sterile and defocusing form within the computer. I was reminded by him that “Everyone knows computers dramatically increase the documentation burden, with negligible value, if any, created for the physician doing the documenting.” His position was that to the extent information technology in the exam room had some positive impact, it was at most minor. And in any event, the net of HIT applications was negative for both patient and provider satisfaction.