My doctor must be listening; after all he is busy typing my answers to his questions into his laptop. Occasionally he lifts his head for clarification: “did you say it was your left or your right?” missing the subtlety that I am holding my injured arm protectively with my good arm.
As a consultant whose mission it is to convert physicians from the paper record to the EMR how should I respond to physicians who genuinely lament what they perceive as the devaluation of the skills of listening and observing in favor of documenting electronically? My generation of physician was trained to value a visit as an opportunity to go beyond the words spoken and to intuit the facts from the subtleties of expression, voice and body language. Further, they complain that documenting into the EMR makes the visit sterile inhibiting the environment of safety and trust so important to the doctor-patient interaction. Osler said that “listening is unspoken caring.” Do our patients feel cared for? Do they sense our compassion?
Rightly or wrongly, let’s assume that the new generations of physicians graduating from our medical schools have the skills to document while they listen, observe and instill trust. Furthermore, let’s assume that the new generation of patients have a matching set of expectations for their physician encounter. What about the rest of us?
For “older” physicians our relationships, both personal and professional, have never been “virtual.” Very few of us Twitter or text message. Even if we master the technical skills of data entry it still alters the way we relate to our patients during a visit. Our ingrained behavior, and for many our sense of satisfaction, demands an intensity of personal face to face interaction. We strive to key into the emotional and social stresses that make each patient unique. We can’t have one comforting hand on the patient and one on the keyboard. Demographically, most of our patient population too is of the “old school.” They expect to continue the style of relationship that they have become accustomed to with their physician, not just receive a diagnosis and treatment.
I can expound the benefits of the EMR, the PHR, evidence based medicine, clinical decision support and electronic prescribing. I can counter the complaints of cost and initial lost efficiency. The bigger question is how do I allay the fear, real or perceived, that a most cherished skill set and a style of relationship could be denigrated and potentially extinguished by adoption of the office EMR?
"To cure sometimes, to relieve often, to comfort always."