Doctors, Patients, Old and New

February 2, 2013

There’s this tension that I pick up on when I talk with patients.  It’s the fantasy of the new and the old.

It’s the fantasy of the physician encounter where a doctor will look at us and never to a screen.  We insist on all of the affordances of the digital age with the human connection of a time gone by.  We want an intensely human connection but we want everything flawlessly documented, reviewed, flagged and cross-checked in the EHR.  We want to spend lots of time with the doctor but we also want to send an unlimited supply of emails (2,000 words, one paragraph).   We want desperately to be human but we glorify transhumanism.  We want to know that we have the ability to make decisions while at times we want our doctors to make the decisions.

We talk endlessly about the power of the story and the importance of patient narrative but we want desperately to be recorded, uploaded, graphed, and analyzed.  We don’t want to be seen as a number but we demand that our numbers are seen.  We insist on laws to protect our privacy yet we yearn to have our stories heard.  We worry lots about data and less about wisdom.  We want doctors who will stare, touch, talk, laugh and connect while at the same time remaining glued to a screen and available 24/7 in 140 characters.  We criticize those docs who refuse to accept the independent e-patient but we swoon when Abraham Verghese paints a romantic picture of 19th century paternalism.

We want the best of the analog and digital all rolled up into one.


{ 8 comments }

Cheryl Handy February 2, 2013 at 10:14 am

That was like poetry. Perfectly said.

Robert S. Miller, MD February 2, 2013 at 10:26 am

Bryan, you’ve nicely covered this duality here. Another dynamic that plays into this is the hostility many physicians have toward aspects of technology that they feel were imposed upon them, specifically electronic health records. And it’s not as if that sentiment is at all underserved, given rampant problems with usability and lack of interoperability with the systems we are forced to use. However, speaking as someone involved with the imminent implementation of a new EHR system at my institution, I know this – physicians have to lead by example in learning to use technology optimally and promoting a patient-centered and quality-of-care focus. It’s easy to snipe at meaningful use requirements and tone-deaf vendors. What’s really needed are docs who are willing to do the harder work of educating each other in using new systems and thoughtfully evaluating opportunities for change management. I think we need to step up as a profession to defuse some of the tension and magical thinking you’ve observed.

DrV February 3, 2013 at 2:10 pm

Beautifully put, Bob. You should lift this as a freestanding blog post.

So long as we don’t participate in the process of defining our workflows, others will be happy to define them for us.

Of course, I enjoy a little magical thinking every now and then.

Kathryn Bowsher February 2, 2013 at 4:49 pm

I think most patients want a high trust relationship with their medical team and healthcare that is both reflective of their priorities and connected to their daily lives. They are as baffled as most physicians as to how you achieve that in today’s fragmented, communication challenged, regs and liability driven healthcare system. Dysfunctional tech issues are a symptom as much as a cause.

Cheryl Handy February 4, 2013 at 9:37 am

Patients and physicians need not be baffled. I am admittedly a lay person who helps physicians with social media and advocates for patients. I am also concerned that those of us who advise about social media without actually being physicians have unintentionally hi-jacked/complicated an otherwise simple, beautiful relationship: the actual physician-patient relationship.

I hear it from doctors everyday: “I just want to practice medicine.” Of course they do. Social media was never intended to complicate the relationship. At least it should never have been the intent. But, just as physicians sat back, “just practiced medicine” while politicians re-defined the medical system, physicians have allowed “patient portals” & semantics of “consumer” and “medical care provider” complicate the very simple physician-patient relationship.

Like technology in any part of our lives, the human element must remain first and foremost.

reshma rakshit February 3, 2013 at 1:26 pm

Hi! I have recently subscribed to your blog- excellent stuff. We were taught and still teach med students about the importance of “looking at the patient” and listening carefully to prevent patients feeling ignored. It is so old-fashioned and unfortunately, the basis of so many complaints. I practice in the UK and we dont even have proper mobile reception in the hospital I work in (and many in the country) to answer calls, leave alone, getting info at the press of a button on our smartphones!!

medrecgal February 3, 2013 at 8:51 pm

Well said, Dr. V. As someone who’s been on both sides of an EMR, I can totally understand this post. I will be the first to admit I liked it better when there wasn’t a screen always present, and yet, I can also totally see the value in being able to more directly connect with a provider via e-mail, flags, etc. when there’s a question that needs answering but doesn’t warrant an office call. However, I would never dream of sending my doc/NP/PA a 2000 word e-mail. That’s just insane…and inconsiderate of their time, to boot. As with many other things, moderation is the key. Technology is useful for many things, but you’ve also got to keep the human side of medicine in the picture. Otherwise we wind up in some sort of “connected but disconnected” paradox that’s detrimental to all involved.

Julian Hinson February 5, 2013 at 1:37 am

Greetings Dr. Vartabedian,
As usual you’ve hit the nail on the proverbial head.
As a medical student (Meharry) I’m ever torn between the intensely old-school training I’m receiving (heavily focused on the “physical” aspect of physical diagnosis) and my life as a techie and former scribe.

I was interested as to your thoughts of medical scribes in positions beyond the emergency room, and whether patients should learn to be comfortable with the “third wheel” so that they can receive the one-on-one contact with their physician?

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