EMRs displaces medicine’s art. Here’s why that matters.

I know a wise old forester. Ask him any question and he’ll answer, “Well, now, it depends on what you want.”

“Should we clear this underbrush or just leave it?” It depends on what you want.

I realize this can explain any choice we’ve made: that is, we have what we have because, at some level, that’s what we want. In that light, let me discuss electronic medical records.

EMRs can be wonderfully useful. You can not only record acres of information legibly, but can retrieve it from anywhere in the world. Indeed, this is an important advance in the science of health care. But EMRs are not helping health care’s art.

I recently examined a patient’s chart, looking for notes about her emotions while hospitalized, and the effects of her visitors. Usually, this would be in the nursing notes. But all I found was page after page of generic computer printout.

It depends on what you want. If you want nurses to input more and more data by checking multiple-choice boxes instead taking the time to write a few sentences, you’ll write the EMR software accordingly. Just hit “alt-S,” and the program prints out an avalanche of, well, stuff. A visiting anthropologist reading this chart might not even recognize that it describes a human being.

This could be adequate if we see the medical mission solely as diagnosis and treatment of illness, but if we see our task also as caring for a person — that is, witnessing and addressing suffering — this charting style is badly wanting.

Many doctors and nurses are disturbed by such record keeping, simultaneously obsessive and exclusive. Some point to the time it subtracts from face-to-face care. Some claim the requirement mainly facilitates data-mining for billing and marketing purposes. In any case, it displaces medicine’s art, the constant process of feeling and nuance that can’t possibly be digitized.

The artful practitioner knows how to act therapeutically with patients, feels confident making medicine’s many subjective decisions, and is as attuned to intuition as to facts. As physician and poet William Carlos Williams wrote in his autobiography, “To treat a man as something to which surgery, drugs and hoodoo applied was an indifferent matter; to treat him as material for a work of art somehow made him come alive to me.”

That is, it depends on what you want.

Jeff Kane is a physician and is the author of Healing Healthcare: How Doctors and Patients Can Heal Our Sick System.

Image credit: Shutterstock.com

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