I wrote this column while attending the recent annual meeting of Epic users. Epic is the electronic health records giant – home-grown in my own backyard in Wisconsin – that hopes to change the world. Electronic record-keeping means better information for you, better information for your doctor, better all around. Or does it?
That’s the question I get all the time – from doctor colleagues, from patients complaining. They all seem to wonder whether that visit to the doctor just “ain’t what it used to be.” Hmm … so first a bit of history. I started practice four decades ago.
That might seem long like a long time ago, but not to me. I joined Dr. Kellogg and Dr. Dukerschein. Kellogg was in World War II and Korea and Duke was “just” in Korea. Fine guys, part of the Greatest Generation. Before I joined them in our small town of Oregon, by the way, there were no fast food restaurants and no stoplights back then, and you just had to dial five numbers if you were in town and wanted to speak to someone else in town. A small place.
For nearly 30 years of their practice, these two doctors were on call every other night taking just two weeks of vacation each year, with one of those weeks spent on Continuing Medical Education. They didn’t have pagers; when they were on call, they stayed at home just in case the phone rang. And ring it did! When a mom was delivering a baby, they went to the hospital and just sat. They did 50 to 100 deliveries a year. And when patients came to the clinic, each person took a number and waited.
Sometimes these docs saw 50 patients a day – episodic care for sure. Certainly not the kind of care you and I get today, by far. So how much time did they spend with each patient? Right! They may not have had a computer screen for work, orders to sign or documentation to type, but they did have another patient in the waiting room waiting to be seen.
These doctors looked you in the eye when you were there, that’s for sure, because they usually put down their diagnosis right on the spot along with the name of the drug they prescribed. Do you think that kind of medical care, that type of documentation, would fly today? I don’t think so, either.
When I joined the practice in 1978, things were beginning to change. People were living longer, and they wanted tests such as mammograms and cholesterol checks. We were treating high blood pressure, ordering colonoscopies. Frankly, it has morphed into a different kind of care.
From an urgent care practice, with pap tests and continuing prescriptions, it became a more robust long-term care that was beneficial to every patient. We have gained about 10 years of life for people ages 50 and older than we had when LBJ was president. Of course, that’s partly due to less smoking, better food, more exercise – all those lifestyle issues that improve our lives.
But it’s also due to advances in medical technology: blood pressure, blood sugar and cholesterol control; picking up breast cancer and colon cancer earlier; joint replacement so we can walk and play well into our 80s; a stroke reduction of nearly 80%; a heart attack reduction of almost that much; and the list goes on.
So where does this fit in with electronic health records? There are a number of ties. First off, you now have access to your data. You can see your numbers, know when you need to be immunized, what the clinician said at that last appointment. Knowledge is power.
Medical knowledge for you is power and education. You’re more likely to ask, “What does this number mean?” if you know what that number is. Handed a printout at your doctor’s office or looking it up online never happened in the good old days.
This also is better for us clinicians. We can see data that we could never see before. Back then, if you had problems, you had a thick chart. Do you really think we could go through that chart and see everything?
If everything in your email was down on paper instead of kept electronically, I bet you couldn’t go through all your printed messages from your best friends and kids and pick out what was important. You just couldn’t handle the data on paper. We need a computer to help us.
The same is true for medical records. We’re living so much longer, and the data is humongous. And then there were the mistakes that happened when we relied on paper records – mistakes in ordering tests, in ordering prescriptions. All those scribbles written down on the Rx pad sometimes resulted in sending a drug to the pharmacy that the patient was allergic, for example.
My spin: Electronic records help with all of these things and so many more, but we should keep a couple of things in mind on this front. For patients who may be kvetching about how their doctor isn’t paying attention to them, that they’re just looking at the screen, I advise them to speak up to that clinician.
Tell them – nicely, of course – that they’re not looking at us, and it would be much better if they would. That will get their attention, for sure. And if not, then you know what time it is – time to change docs. And if you’re a clinician, learn to tame the electronic beast.
Study after study has shown that if you take time when you’re not seeing patients to learn efficiencies in electronic record-keeping, then you can spend more time caring for patients and less time staring at the screen. More efficiency means less burnout. It’s not a perfect answer, but, then again, there is none.
We are in a fine time – better food, fewer toxins, more opportunities to stay fit and wondrous medical technology. In 1900, the average American lived to the ripe old age of 49. Today, we’re averaging more than 80 for women and moving up near there for men.
Electronic health records are part of this health miracle. But just like television, like the iPhone, like all technology, we have to learn how to harness it for our own good. We control it – it doesn’t control us. Stay well.
Dr. Zorba Paster is a family physician and host of the public radio program “Zorba Paster on Your Health.” He can be reached at email@example.com.
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