We talk a lot in critical care medicine about liberating patients from ventilators. Vents are getting a lot of deserved attention for saving lives in the COVID-19 era. But the machine has downsides that get worse the longer the patient needs it.
Because we’re obsessed with taking great care of our patients, we in ICU medicine obsess about ventilator liberation. There are thousands of publications on the topic. Vent weaning protocols are ICU religion. When I round in the ICU, I make sure every patient who qualifies will get their daily chance to wake up and breathe on their own.
What would we do if we turned this obsessive caretaking lens toward ourselves? Doctors have a patient-first mentality, which absolutely makes sense when you’re saving a life. Putting the patient first, day in and day out, leads to a hard-driving and self-denying culture. And when we look closely at ourselves, we are hurting.
This brings me to the ventilator analogy. There is a technology that’s a necessary evil in our lives, that we can’t function without: electronic medical records (EMRs). We need EMRs to do our jobs, but the more we use them, the more we feel jaded, boxed in, and worn out.
EMRs and data entry requirements are killing us by a thousand cuts. Is bad technology to blame for all burnout in medicine? Certainly not. EMRs are often a vehicle for administrators enforcing inane requirements, like all the countless times the documentation police have asked me to revise a note where the template unacceptably printed “no past surgical history on file,” and I have to revise it to say “no relevant past surgical history.” There is no reason in hell or on earth why this matters, but someone has a box to check, and a doctor must check it.
There’s no one magic cure for our EMR problem. But like good critical care, there is a recipe of best practices that, taken together, can actually save us.
Here’s another ICU analogy. Let’s talk about fluid management. Sometimes, in a patient with sick lungs who can’t get enough oxygen, removing fluid can help the patient breathe. But removing fluid isn’t the answer for every case. In a patient with hypovolemic shock, her circulating blood volume isn’t enough to get oxygen to her organs—this patient needs more fluid to save her life. (When both happen at once, then critical care gets interesting.)
Building great tech for doctors is no different. In some scenarios, you will want to talk to the EMR like you talk to Siri, rather than poring over a screen littered with boxes and lists. In other cases, you will want elegant graphs intuitively laid out to show how your ICU patient is progressing. Other solutions will go unnoticed aside from the time they save by eliminating double work in the background.
A great technology team builds products with all the attention to detail that we devote to our patients. This is how we will liberate doctors from EMRs.
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