In the age of EHRs, don’t turn your backs to patients

One of the most important tricks of the trade that I learned in medical school was what some might have considered a little throwaway bit of advice.

During my psychiatry clinical rotation the preceptor advised that, when applying the stethoscope to the patient’s back, one should rest the other hand gently on his or her shoulder. Human touch was important. It would relax the patient and convey subconsciously a sense of compassion, a feeling that we’re in this together. I decided to take that advice and throughout my career always touched my patient’s shoulder with my left hand while I was listening to his or her lungs. I don’t know whether this technique “worked.”  Not one patient ever commented on it.

But there must be some reason I had such a good rapport with the majority of my patients. Of course this may have been unrelated to the shoulder touch. Maybe it had more to do with looking patients in the eye when talking to them, paying attention to what they said, showing I paid attention by asking appropriate questions, expressing concern and compassion, always shaking their hand when I entered their room, or perhaps some other unconscious body language that put them at ease.

When I was professor of medicine at the University of Colorado I told students that medicine is both a science and a humanity. This is what is emblemized by the phrase “the art of medicine.” In recent years there have been great advances in the science of medicine, and one could be forgiven for believing that science is all there is to it. Medicine as a humanity is less well studied, less well understood. Changing age-old practices that affect the doctor-patient relationship may have unforeseen consequences. Changes like more rushed, shorter patient visits;  doctors turning away and seemingly ignoring their patients while furiously entering text into an electronic health record (EHR) on a computer; or telemedicine with doctors miles away in front of a television camera. Changes like doctors who don’t relate to patients on a personal level, who don’t have long-standing relationships with patients, who aren’t in touch with their patients.

Long ago, when there were only a few legitimate drugs, and many bogus ones — maybe 50 years ago, certainly 100 years ago or even take it back to Greek and Roman times — there were still doctors. They didn’t have much to work with scientifically. They didn’t get results the way doctors today do.

But I wouldn’t discount the possibility that they got some results; in fact sometimes good results. The science of the mind is not well understood. Placebo effects are small, but real effects. Calling in the wise-looking, well-dressed gentleman with the black bag full of mysterious pills and injections, with the comforting voice, with the laying on of hands, the careful physical exam — I’m sure all this had a beneficial effect, regardless of the lack of treatments backed by randomized clinical trials .

I’m not for going back to those times — we are far better off with good science backing our therapies. But aren’t we losing an important tool in our armamentarium? Patients need our firm handshakes, the touch of the stethoscope, our thoughtful advice.

When our health care practice purchased an EHR I resisted the urge to use the computer in the exam room, even though it was slower for me to do my notes in the privacy of my office. I didn’t want to turn my back to my patients. The people who want to increase constantly the amount of electronic documentation we need to enter into the computer don’t understand this. We need to increase the time with the patient and decrease the time with the computer. We need to be in close communication with our patients as one human being to another. We need to relate on a human level, not electronically.

We should never turn our backs to our patients.

David Mann is a retired cardiac electrophysiologist and blogs at EP Studios.

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