Art of medicine | Electronic medical records | Doctor-patient relationship
Communication with your patient is the epitome of the Art of Medicine. It is vital that physician and patient understand each other. This includes not only what the patient say…

Paul Ravetz: Can the art of medicine exist in the computer age?

In today’s post on KevinMD,  Paul Ravetz recognizes what most of us already understand (where the rubber hits the road).  Tell it to the HIT group, salivating  over the ARRA.

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I think it’s an individual basis. Some docs are technophiles, and put that first. That ain’t right.

Some docs are so intent on listening, that they may forget a detail, and then it doesn’t get entered later. That can also lead to problems.

The key is a happy medium. Sometimes you just instinctively know when you shouldn’t be typing away.

I put routine info into the computer on the fly- like allergies, a medication list, etc.

But for their current story (why they are there) I try to keep good eye contact and listen. I have a notepad in front off me, and while listening scribble stuff down so I don’t forget details, while they talk. For some reason patients don’t object to jotting down notes while we’re talking, but would get irritated if I did the same on the computer. Maybe they assume I’m actually surfing or sending email.

I recognize the desire of some for EMRs, but that desire is far from universal. I would urge you to understand the reasons for reluctance to depart from a standard before you go about instituting a new standard. In doing so, you may increase your understanding of what is needed in that new standard.

I say all that to say that I have found that the best “hybrid” scenario is to use the electronic health record as a tool to quickly retrieve data but to still dictate notes and use a transcription service with fast turnaround and have that note scanned into the chart. This enables the physician to spend more time with the patient, do more complete notes and documentation. If we are relegated to assign patients to either “templatable” or “non-templatable” diagnoses, we are not doing what we trained to do.

The benefits can be pretty significant. I’m still only a med student, but at institutions that still use paper charts, there have been patients that I only have information from some random nurse’s progress note, because it was legible. Lots of specialized physicians probably put some pretty essential information into the chart, but if it’s completely unreadable, it might as well have been thrown in the trash. Pretty sad.