Technology and the doctor-patient relationship

I often hear people talking about their doctors.  I overhear it restaurants, nail salons, while walking down the street. I hear what people think of their doctors, what their doctors said or what they didn’t say, why people were disappointed by or validated by their doctors.  I hear people analyzing, criticizing, and surmising about this relationship quite a bit, and I don’t blame them. The relationship you have with your doctor is a critical one, and yet it is fraught with misunderstanding, disappointment, and distrust. People didn’t used to doubt their doctors the way they do today, and I believe the essence of the doctor-patient  relationship has degraded in our culture.

In large part, I believe this is due to technology.

The Mayo Clinic recently announced they have partnered with Apple to create what they call the Health Kit.  Although the details are still unknown, the product is supposedly one that will allow patients to become more involved in their health care, from diagnosis to treatment delivery. This has always been the doctor’s job, but with the technology booming, it is no surprise that the next step would be computerized health care.

So is this a good thing, or a bad thing? I have mixed feelings, and I think the results will be mixed as well. Statistics show that positive relationships and supportive interactions with others are crucial parts of living a healthy life. Can a computer ever truly replace that je ne se quoi that occurs between a doctor and a patient?  In my own practice, I would like to believe that the interaction between my patients and myself is part of what leads to healing. I don’t believe a computer could do that as well as I can.

Here’s the problem, though.  Doctors are inundated with demands from insurance companies, paperwork, accountability measures, and check lists upon checklists required for medical records, billing, and measurable use. This situation worsened several years ago, with the mandatory implementation of Electronic Medical Records, and then even worse since the implementation of the Affordable Care Act.

These changes have also affected patients, many of whom have had to drop doctors they have had for many years because those doctors didn’t take the new insurance. The message, whether stated outright or not by advocates or detractors of the new systems, is that this doctor-patient relationship is not really all that important.

I can tell you that as I type into my computer while seeing a patient, clicking the right boxes, filling in the right spaces, we both feel the demand on us, and the oppressive requirements of a system that has stopped supporting conversations and looking each other in the eyes when speaking. Many of us take notes and go back, after we can close the door on the patient we just saw, but this adds multiple extra hours to a doctor’s day, and isn’t always practical. After a few hours of patient after patient, you forget the subtle signs you notice when looking at someone — the things you see that the patient doesn’t directly tell you. As a die-hard believer in the human connection, I want to believe that people and interactions and human form, touch, voice, and emotion do make a difference in the pursuit of wellness.

On the other hand, there are benefits to the new technologies, and honestly, I can’t wait to see the Health Kit, and other innovations that help people care for themselves.  As obesity and diabetes rates continue to rise, as Americans continue to over-consume foods that are not supportive of health, we have to admit that something isn’t working. Maybe an app, a kit, a technology can succeed where a doctor simply telling a patient to go on a diet and exercise more has failed. So, as a doctor, I will continue to stroll down memory lane and hold on to the last vestiges of feeling like and acting as a healer.

At the same time, I plan to open my mind to the next generation of people getting healthy through technology.  I’ll use technology if and when I have to, especially when I see it working. However, I will also always be there for my patients when they need a hand to hold or a shoulder to cry on, or even someone to just listen to their heart with an old fashioned stethoscope. I can share the job of healing with technology, but I will never let go of my part in it, either. I hope many other good doctors out there feel the same.

Suzanne Steinbaum is director, women and heart disease, Lenox Hill Hospital, New York City, NY.

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  • southerndoc1

    “the mandatory implementation of Electronic Medical Records”

    Sorry, but it is not mandatory. If you’re using an EMR, it’s voluntary.

    • Dr. Drake Ramoray

      For independent practices you are correct. The author is a director of a center at a hospital. While I can’t say for certain that the use of an EMR is mandated in her contract, I’m sure it would more than ruffle some feathers if she viewed her EMR use as optional.

      Yes, independent practices can avoid using an EMR if they wish, but as more and more docs decide to work for large hospitals or mega corporations this is becoming a relatively moot point.

      One of the reasons for all of these mandates and requirements is to herd doctors into ever increasing larger groups (a factor sorely missing inthe destruction of the doctor patient relationship in this article) thus making then easier to control via insurance/goverwnt mandates. What is happening to medicine is very similar to what happened in finance that yielded the too big to fail banks. Small local independent banks get strangled by the bureaucrats with their mandates.

      2013 first time ever the majority of new doctors started work for a large corporation or hospital as an employee. The independent doc is a dinosaur and you don’t see many community banks either.

      • southerndoc1

        “I’m sure it would more than ruffle some feathers if she viewed her EMR use as optional”

        Isn’t our reluctance to ruffle a few feathers exactly why we’re in this mess? This victim mentality we’re falling into sure isn’t going to improve things!

        • Dr. Drake Ramoray

          I don’t disagree, but I don’t think there are any “directors” out there who would be willing to risk their job over the EMR.

          As for the new docs, it would be nice to hear from some new docs about whether or not using the EMR is included in their contracts. Don’t use the EMR then no job is my bet. Once employed then dismissed for breach of contract if stop using the EMR. I actually wouldn’t be surprised if the same thing is in place for the author (which was sorta the point).

          • The Patient Doc

            My new contract clearly states that I must use EMR.

          • Dr. Drake Ramoray

            Yup, can’t imagine any hospital not having that requirement. It’s not very optional and is unlikely to improve without unionization. I suppose one can always choose to go the direct pay route, but then you will be outpatient only (which probably doesn’t work well for man). It should be ok for my thyroid only practice.

  • JR

    Why do I distrust doctors? Because during my childhood I watched other children be medicated against their will into lifeless zombies? Because I’ve seen multiple people be harmed by over treatment? Because my grandparents bodies were kept alive for years after their minds were gone?

    • Margalit Gur-Arie

      Just curious, do you trust computers?

      • JR

        Computers are rather neutral, it’s the people accessing them/using them that are a problem.

        • Margalit Gur-Arie

          Well yes, but computers are just inanimate piles of metal and plastic. It is the software running on them that makes them do something, and that software is anything but neutral, because it is created by people too.
          The examples of doctor behaviors, that cause you to mistrust them, are not going to be preempted by use of computers. We are just shifting the locus of mistrust from individual physicians to unknown entities that generate software used to guide the provision of medical care.
          And they also generate the content you are planning to use to verify that doctors or computer-doctors are treating you right, including the much touted evidence base, and patient education materials, or “decision aids”.
          The thing is that we are quickly approaching the “trust no one” paradigm…. and this is entirely our fault, patients and physicians included.

          • JR

            I’m just pointing out that “technology” hasn’t really impacted my view of the medical system – watching people in the medical system has.

          • Margalit Gur-Arie

            Sure… makes sense….

          • Patient Kit

            I agree that trust is a huge issue and I hope we can find a way out of this “trust no one” culture. Once lost, it is extremely difficult to get trust back. But it’s so important, it’s worth trying.

            It’s not just medicine though. Virtually, everyone we used to trust, perhaps too blindly, has been tainted by knowing about pedophile priests, police brutality, teachers having affairs with students, bad doctors and abusive parents. The eroding trust in doctors is a part of that big picture. And the only way to rebuild trust is to build relationships. If we’re not going to take the time and effort to build and nurture patient-doctor relationships, we are not going to trust each other.

            The trust problem is so enormous, I think the only real way to regain trust is to rebuild it individually, one by one. Personally, I trust my GYN oncologist with my life. Maybe that makes me an idiot. Maybe I just need to trust him. But he also got me through a major crisis and surgery without complications and has been compassionate,, communicative, accessible and he treats me like a whole person. I also have really learned to trust my instincts about people.

          • Dr. Drake Ramoray

            You make some very good points about bit society and the doctor patient relationship. Of course the corporate ACO/PCMH where you see a random provider moves in exactly the opposite direction of what is needed to fix medicine.

  • HJ

    I had a paper chart when I got sick. I have never had to change doctors because of my insurance company. I never developed any je ne se quoi with my primary care physician because she felt I wasn’t sick enough for an appointment with my doctor. None of the doctors in my area see patient for urgent appointments…what difference would it make if my insurance company makes me switch doctors.

    And then there was the misdiagnosis after misdiagnosis…mostly from a failure to listen and trust me. I would welcome an electronic doctor at this point

  • Anne-Marie

    “O unhappy citizens, what madness?… I fear the Greeks even when bearing gifts.” They didn’t listen to Laocoon, and look what happened.

  • buzzkillerjsmith

    Yeah, that made me scratch my head too. She was saying how much EHRs suck the life out of us, which they do, and then she says she can’t wait for more apps. It hurts so good.

    Does she really think that we won’t be involved in wading through the mass of information, much of it noise, that will be generated by all this stuff?

    Well, she’s spending a couple extra hours per day on the EHR already. What’s another hour or two after work?

  • JR

    Computers weren’t even in the picture when Doctors started losing the trust of the public.

  • Carolyn Thomas

    Thanks for this Dr. Steinbaum. Technology in medical practice is here to stay, although I have my doubts that “an app, a kit, a technology can succeed” in changing health care as we know it. Why would we believe, for example, that an app will work where mirrors and bathroom scales have so far failed?

    I spent over 30 years with my (former) family physician who kept decades of my medical records in a bulging beige file folder, papers spewing out as she entered and exited the exam room during each visit. Even the simplest question like “How did my last blood tests look?” meant at least a minute of watching her flip papers back and forth in search of the labwork, and this “system” also meant that over the years a number of important documents were lost or misplaced by accidentally being filed away in some other patient’s beige folder. This was and is a crazy way to keep track of important and sensitive medical information, and I’m pretty sure no doctor is insisting we cling to this kind of poor organizational tools.

    Yet I’m so glad to read your final paragraph, because it reinforces my ultimate hope that, when I see my first Google-Glass sporting physician entering my exam room or ER cubicle, a sense of old-fashioned common courtesy and humanity will remain when I politely ask that doc to remove them.

  • HJ

    I am looking forward to an electronic doctor…not an EMR. A computer program that could take your information, come up with a differential diagnosis, etc…Most of the doctors I have seen are just using an algorithm…

  • HJ

    I was sick for 18 months while my PCP ignored my symptoms…offered me Prozac.

    Sorry to hear about your issues. Perhaps an electronic doctor would have ordered that strep test.

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