Entering the exam room without the weight of the computer

It started with a dead laptop. For the first time in more than 3 years I felt like a doctor again. I had forgotten what it was like.

Having neglected to plug in my laptop the night before, it was without power. (Without power!) An opportunity for an uprising, of consciousness if not full revolt.

For the first 1½ hours of clinic I entered each exam room without the weight of the computer. I felt light, free and focused. I could make eye contact and concentrate on the patient. There was time to visit about little things and big.  And on this foundation of social conversation, which otherwise would get only scraps of distracted attention, the medical care was better. I was a better physician.

My mind was not divided into multiple trains of thought, with more synapses devoted to navigating the electronic obstacle course than to the patient: what is the new password that changes every 3 months, be sure the nurse has finished entering her structured text information before I select the patient or her work vanishes, wait 35 seconds for a page to load. Click here, wait, scroll there, wait. Click away automatic pop-up error messages that can’t be avoided. Sting, slap, brang.

In contrast, for a brief Camelot moment I wasn’t working with one eye on the patient and one eye on the screen, but found myself enjoying my work. A lot. I wasn’t doing tasks, such as submitting the billing invoice or closing the chart, that either meaningful use panelists, local administrators or technology vendors had intentionally or arbitrarily determined could only be done by a physician.

All that mental noise, all that multi-tasking quieted for a blissful 90 minutes. I focused on my patients and didn’t have the master over in the corner waiting to devour minute after minute, putting me further behind, and gnawing at my identity and conscience. It was bittersweet. I had experienced a tantalizing few moments of what I knew should be, but couldn’t last.

I believe that we can not overstate the costs to patients, and to physicians’ and other health professionals’ well-being of the quest to convert every clinical thought and act into digital data. Of creating an environment that approaches physicians as knaves not to be trusted or pawns to be manipulated, rather than knights to be entrusted in the service of their patients. We need electronic systems of information. Paper is not good enough. But we need a more sophisticated socio-techincal-policy environment that allows physicians to unplug their focus from data entry and refocus their attention on connecting with the patient.

Christine Sinsky is an internal medicine physician who blogs at Sinsky Healthcare Innovations

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  • buzzkillersmith

    “We need electronic systems of information. Paper is not good enough.”

    I have not seen the studies that prove those two sentences are true, if by EHRs being good enough you mean better pt care for less money.

  • Lisa

    I have watched doctors shuffle through my chart looking and not finding the information they were looking for, so it is pretty clear to me that paper alone is not all that efficient. I’ve also seen doctors use electronic records in such a way that they are not intrusive. I particularly liked it when doctors dictate their notes while I am listening – very useful to me as a patient to hear the summary.

  • Brian P. Curry

    This is part of the reason why, as a medical student, I rarely use the computer in the exam room while I’m interviewing the patient. Sure, if I need to look up something specific, I’ll sign on and get the information I need. Otherwise, I much prefer to maintain open body language and good eye contact, occasionally writing salient information down on paper.

  • southerndoc1

    “I focused on my patients and didn’t have the master over in the corner waiting to devour minute after minute, putting me further behind, and gnawing at my identity and conscience. It was bittersweet. I had experienced a tantalizing few moments of what I knew should be, but couldn’t last.

    I believe that we can not overstate the costs to patients, and to physicians’ and other health professionals’ well-being of the quest to convert every clinical thought and act into digital data.”

    Once again, Dr. Sinsky demonstrates her complete inability to follow her thoughts to their logical conclusion.

  • Suzi Q 38

    I like it when I send my records or updates to the physician before my appointment, and h/she actually reads them before h/she comes in my exam room.

  • Rginsberg2

    Well said. Connecting with the patient is the heart of medicine. The heart of health care. Our patients expect it. We need to revise our data-collection system to give much, much more of it. If not, our patients will suffer and we will burn out soon. 50% of wellness is connection.