The young doctor’s organized orientation to electronic dehumanization

“It looks like you’ve done very well, Mr. Smith.”

“Thank you, doctor.”

He left the patient’s room and ambled back to the nurses station, legs tired and ankles somewhat swollen.  It had been a long case and now he just had to type his note, send an email message, and review his schedule for the following day.  He sat down at the computer and logged in.  That’s when he looked up briefly and saw them.

They looked so young.  Their newly pressed white coats accentuated the faint glow of the computer screens on their perfect skin.  They looked like thoroughbreds, while he the old horse put to pasture, if they had noticed.  But they were each staring intently at the electronic screen arranged along the desk countertops, one with his back to the other two.  Occasionally the one would turn to ask the other two a question, then return with a blank stare to the screen before him.  The new residents had arrived.

“So different,” he thought.  There they are, seated before a computer looking more like telephone operators rather than doctors.

“What were they thinking?” he wondered silently, then pondered how things had changed.

For now he realized that they didn’t have to know where the blood or microbiology laboratories were.  They didn’t have to search for an x-ray.  Instead, they had to find which button to click.  This day, this moment, was probably their dream come true.  For it was the day they had waited and worked so hard for, the day they became a working doctor.  Underneath the electronic facade, they were probably excited, eager, wanting to do a good job: excitement and anxiety, all rolled up into one.

But somehow, it was different.  The new doctors rarely looked at each other as they stared vacantly into their computer screens.  It was as though they were transfixed by medical porn.  It looked as though they were being bred into an interchangeable electronic medical documentation team, not a cohesive, personal one equipped with interpersonal skills.  After all, they really didn’t have to see or listen to each other any more. They could send each other an email, text messages, or chose to stay isolated, listening to the rapid fire clicking taking place next to them.  Emotionally and physically, they could be miles apart or seated together, it really didn’t matter any more.    It was so efficient, so neat, that their organized orientation to electronic dehumanization required very little movement, very little patient contact.

But young doctors, he realized, were meeting their patients like they’ve always met new friends on Facebook: electronically first.  Was this better?  He wasn’t sure.  Would the initial impressions garnered from the chart skew their ability to look independently and objectively at their patient?  Will they be capable of accurate empathy?  Will a patient’s undocumented concerns be missed?  Will new doctors forget to use the subtle signs and symptoms brought forth by the physical exam to head off disaster or just wait for the test results to return before reacting instead?  Will they see enough, smell enough, do enough, sweat enough, to learn enough?

He wondered.

But they were young.  They could learn.  They would learn.  They’d adapt.

And they could type faster.

Perhaps.  Maybe.  We’ll see.

“I can only hope,” he thought, realizing he wasn’t getting any younger.

He turned his gaze back to his own screen and clicked the icons slowly, the way he had done hundred of times before, filling his note with voluminous immaterial drivel the government required, then added a single line.

“Doing well.  Home today.”

So meaningful, he silently quipped, meaningful indeed.

He rose to say goodbye to the unit clerk, who smiled as she peeled her eyes from her iPhone, “Goodnight, doctor.”

“Take care of the new guys, okay?” as he pointed to the people behind her with the new white coats.

“You bet,” she said, not turning to see them.  Her eyes reset to to her iPhone screen instead.

Wes Fisher is a cardiologist who blogs at Dr. Wes.

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  • bruce

    You hit the bullseye, Dr. Wes. Patiient care is often a room full of young physicians typing.

  • Kerry Willis

    Sadly you are correct and they will spend their time studying the screen as their geek attendings with their gadgets find new ways to stump them and impress themselves with their knowledge.

    I fear for the future as many of them are unable to take a history without having it spoon fed to them from an EMR.

    EMR and gadgets main innovation seems to be negative rather than the positives that were promised

  • David Mokotoff

    Excellent blog. I could not agree with you more. Reminds me of the old song words saying, “something is lost but something is gained…”

  • Raddoc

    I just finished my Critical Care rotation and I felt disconnected by the amount of time I had to spend writing every single Q2 lab ordered, image and overnight events that happen for one patient. It took me nearly an hour to finally get a picture of how the patient was doing. Worst part was examining the patient was and is still always last on the list of things to do before rounds; to which we only invest anywhere from 1-5mins max.

  • Dorothygreen

    “Will new doctors forget to use the subtle signs and symptoms brought forth by the physical exam to head off disaster or just wait for the test results to return before reacting instead? Will they see enough, smell enough, do enough, sweat enough, to learn enough?”

    What is mostly missed are the pieces of the diagnosis puzzle that cannot be smelled, cannot be seen even by imaging or the numbers on , cannot be heard with a stethoscope, cannot be touched. It is patient information that is uncoordinated and incomplete. Technology is not a tool to be used in lieu of the physical examination but to compliment it. The uncoordinated and incomplete information can lead to a wrong or missed diagnosis or inadequate or wrong treatment. Information technology is critical in helping health care providers correct this deficiency.

    The scenarios described in the article and in the comments are transitional. Technology is evolving. There is no turning back. New physicians will soon learn the essentials and importance of a physical examination from that screen better than from a book, with 3D, interactive techniques, and other innovations not even imagined. This will prepare them that should surpass what their “elders” were able to do in physical examination.

    Use of information technology should, and I believe it will, be a synergistic tool in the physical examination and medical history – not a trade off. Patients will become more involved with their diagnosis and treatment as a result of the internet. This could be a tremendous help to providers. The caveat: too many are still intimidated or dismissive of knowledgeable and questioning patients.

    As a patient, I have used the internet extensively to understand my medical conditions and have asked questions, have refused treatment, have changed physicians because of their resistance to newly researched ideas or insistence on compliance with outdated protocols. I am not alone. There are many accounts where people avoided further deterioration, death or caught an error because of the internet.

  • Richard Willner

    When I was young, the Patient Was First. As I enter the 6th decade of life, my hunch is that the trend is that the Patient Will Be Last.

    Such a sad reality.

    But the “War On Doctors” is what I focus on. You all know exactly what I mean. And, with much less doctors, what do you think will happen?

    I think it is time for Physicians to take a stand and to advocate for our patients.

    Richard Willner
    The Center for Peer Review Justice.

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