Recently I had to take my son for a doctor’s appointment. He had to go see a Gastroenterologist for a stomach issue he has been having since past few days. As many of us do, we arrived at the doctor’s office a few minutes ahead of time. We go in, submit our new patient paper work and take a seat, waiting for my son’s name to be called. Sitting there I wondered why every single one of the physician office that I visited since last few years still collected paper work instead of some electronic documentation. What made this visit even more interesting is that they wanted some of the paperwork that we submitted to be notarized! Notarized?? Really???
Eventually my son’s name was called we were lead inside consultation area. But before we could see the doctor, we had to meet a nurse sitting behind a desk. She asked my son a few questions and my son started replying to her questions and the entire conversation the lady was working one her computer, noting down the chief complaint, the vitals that she took, height, weight, current medications, allergies etc., and religiously entered the entire data into an electronic medical record system. After she completed her data entry she leads us to a consultation room and informs us that the doctor will be seeing us soon.
After a wait of another 10 minutes or so the doctor walks in holding a open laptop. He greets us, sits down and starts typing before he even says a word. After many a keystroke, he turns around and starts asking questions to my son about his problem. When my son starts responding, he turns about 100 degrees on his rotating stool to reach the laptop and starts typing on his laptop. He does not look at my son, he is only listening and entering the data into his computer. Watching this a thought triggered about how I work at my computer every day and wondered if I could ever type on my computer keyboard and also engage myself with someone in an important conversation at the same time. How effective will I be if I had to do this task myself? Many times I can’t even hear my wife calling me when I’m reading a book or replying to my emails. I always keep telling her that I’m wired to do only one thing at a time and I cannot focus on more than one task at any given time. At the cost of sounding sexist, I think most men are also wired that way. If you are not sure, just ask any wife! On a more serious note, if I had to have an important conversation with someone at my office, I’ll try to remove all the distractions that could divert my attention from that conversation. I’ll silence my cell phone, put my laptop on sleep, tell others not to disturb while I’m with this person, etc.
So, while I was wondering how this doctor is able to pay utmost attention to what the patient is saying and also type on his laptop at the same time, he did something on this computer which made it hang! Somehow that did not surprise because how could he be doing two critical tasks at the same time and do justice to both of them! One of the tasks obviously had to give in. I could notice that his focus is split between recording the information in his system and listening to my son’s responses to his questions.
After a quick reboot, his laptop comes up fine and he completes his note taking. Then he starts clicking on icons, selecting from drop down lists, closes a few alert pop ups, consults a few more screens, reviews his decision support system, enters his orders into an order entry system, chooses labs, writes his prescriptions and then finally starts to explain why he thinks my son is having the stomach problem. In the end he says that the lab orders have been sent to the hospital lab and that the prescription has been sent to our pharmacy.
Sitting there and watching this young doctor, do what he is doing really perplexed me. I got the feeling that even with all the talk going on in the industry about patient centered healthcare and patient centered medical homes, we are still a long way from that goal. It looks to me that physicians these days are spending time treating virtual patients and not real patients. The real patient just happens to be there validating the virtual patient and the virtual patient is getting all the attention it deserves. In fact, the doctor’s focus is being constantly pulled between this actual patient and the virtual patient.
It is only going to get worse before it becomes better because so much of documentation, reporting, and compliance work is being pushed onto the doctors that they are hardly finding time to practice medicine. Their inboxes these days are filled with tasks that have got less to do with actual patient care and more to do with reporting, administrative and financial matters. People did not go to medical school to do these things, and this one I’m sure. I’m really starting to sympathize with the doctors and their tasks.
In my next post I will try to address the issue of what is keeping physicians busy in a practice setting.