Feedback Loop

flying cadeuciiRight now there are two patients in every room. One is made with flesh, bones, and blood. One is made with a monitor, a mouse, and a keyboard.

Both demand my time.

Both demand my concentration.

A little over two weeks ago I wrote the short story Please Choose One. I posted it online. The response it generated exceeded anything I could have ever imagined. It struck a nerve. People contacted me from all over the world, from all walks of life, about the story. Everyone, it seems, can relate to the challenge of having to choose between a person and a screen.

People sent me all kinds of suggestions and ideas. A few sent words of encouragement. Yet, what struck me the most about the people who contacted me was what they did not say. Not a single IT person argued the computer was more important than the patient. Not a single healthcare provider stated they wanted more time with the screen and less time with the patient. And finally, most importantly, not a single patient wrote me and said they wished their doctor or nurse spent more time typing and less time listening.

Medicine is the art of the subtle- the resentful glance from the mother of the newborn presenting with the suspicious bruise, the solitary bead of sweat running down the temple of the fifty three year old truck driver complaining of reflux, the slight flush on the face of the teenage girl when asked if she is having thoughts of hurting herself. These things matter. And these same things are missed when our eyes are on the screen instead of the patient.

I get it. We need to collect the data on patients. In the modern world, medicine is also a business- a business of collecting, sorting, and collating data for billing purposes. I am not naïve enough to believe or argue otherwise. But maybe right now we need to step back and ask ourselves the one question no one seems to want to ask:

Has the data we store about the patients somehow become more important than the actual flesh and blood patients themselves?

One of the most difficult things to do in the practice of medicine is to recognize when a previously established diagnosis is incorrect. It requires having an open mind that maybe, just maybe, the prior five doctors have been wrong. I wonder if we are at a similar point. Maybe we do not need another screen in the room, another page of data, another flag popping up on the screen warning us to address some incomplete part of the patient’s record. Maybe instead, we just need to spend those thirty seconds interacting with our patients.

Computers, EMRs, and patient databases are ultimately a good thing. We need them. I have no doubt that we will reach the point when they can collect all the data they need without inserting themselves between the doctor and the patient. But we are not there yet.

To the IT people out there who were offended by the story, my message to you is clear. You are the very ones who can help save us. Keep working, keep innovating, keep looking for ways to build a better, more invisible system that still does what it needs to do. After hearing from so many concerned people in the IT industry, I have nothing but faith we will find our way together. Ultimately I am reminded that we all want the same thing: to do what is best for the patient.

I am looking forward to the day when I step into a room and there are two providers. One made with flesh, bones, and blood. One made with a monitor, a mouse, and a keyboard.

Both advocates for the patient.

Philip Allen Green is an ER physician based in Walla, Walla Washington. He is writing a book based on his experiences as an emergency room physician. More information can be found at PhilipAllenGreen.com

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