Digital Doctoring

Originally posted May 2, 2013

By Jason Franasiak

I recently came across an old photograph of our labor and delivery board room. The scene contained a smiling attending that I know well along with two other residents that I never knew. The white, lined board detailing the acute inpatients of the women’s hospital was in the same orientation on the long wall of the room. But what struck me was what lay in the background of the photo: a very large and notably solitary computer with blackened screen. This stood in such contrast to the current board room which now contains 7 flat screen monitors each given just enough room to fit a body huddled close to its glowing screen (between medical students, acting interns, residents, fellows, and attendings they are always occupied and there is usually one or two people in the corner on their laptops).

With all the time that I spend during a 24 hour call in front of one of those screens, it made me think: what did those residents do when there was only one screen? What happened when there was only paper charting and the paper chart was actually outside of the patient’s room? I imagine those residents in that picture spent a lot more time talking directly to patients and laying hands on them and less time looking at electronically populated laboratory values, vital signs, and fetal heart tracings.

We are in an era where literally everything said and done is documented and time stamped. Anyone who has received a transfer from an outside hospital accompanied with a redwood tree size stack of nursing notes which always start from the beginning: “4/22/2013 22:32:13 – Patient placed in bed.” I have seen entire nursing and physician intake exams where there isn’t even eye contact with the patient as we tap away at the screen of pre-determined, mostly redundant questions.

I have an attending (and I’m sure you do too) who loves to ask, “Well what did your computer box tell you about the patient?” He is famous for continually reminding us: “When in doubt, talk to the patient!” I have found this seemingly silly mantra to be true on many occasions. It is particularly true with the consult service where someone has obtained a history based on predetermined questions, obtained vital signs, and ordered labs and radiologic studies. Most times, the consult note is 98% done before even seeing the patient. But on a number of occasions beginning with unscripted and more freeform questions such as “What do you think is going on?” or “What were you hoping to get out of our visit today?” yields information that the electronically predestined questions simply can’t and completely changes the tone and direction of the patient/physician interaction.

There is no doubt that electronic medical records are the way of the future in medicine and there are great merits to this system in terms of sharing information and avoiding redundant testing. However, that photo reminded me that very best doctoring is not done in front of a computer and that we should always remember to really talk to the patient.

–Jason Franasiak is the Education Administrative Chief Resident at the University of North Carolina at Chapel Hill in the Department of Obstetrics and Gynecology. He serves on the Kaplan faculty as the Step 2 High Yield OB/GYN section director and the Step 1 High Yield Reproductive Sciences section director. He also reviews and edits Kaplan QBank questions for Step 2. Jason has been active in both research and medical education during medical school and residency, and his efforts have been recognized locally and at national scientific meetings. After residency he will continue training as a fellow in reproductive endocrinology and infertility at Reproductive Medicine Associates in New Jersey.

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