Two recent different news stories point out our need to think more about what we can do to optimize the triage between professional, client and technology. As technology enters the medical consulting room and the legal advocates interview room, there is more focus on what happens when the professional is required to spend extensive time and attention on recording medical or legal information.
The New York Times recently ran “A Busy Doctor’s Right Hand, Ever Ready to Type” on the new job of scribe, who just records the interaction. The point is to allow the doctor to focus on the patient, rather than on the computer.
The significance of this is is underlined by a recent study, reported on NPR, on how rarely doctors do simple communication and trust building things like introduce themselves, or sit down next to the patient’s bed.
In a recent study, Johns Hopkins researchers followed two groups of medical interns for a month and found they sat down at the bedside only 9 percent of the time.
Sitting down, which would seem like one of the simplest things to do, is the least practiced of five communication skills for doctors that Lenore would have endorsed and that research has shown can make a big difference in patient satisfaction.
The others include introducing oneself to the patient and explaining your role in the patient’s care. Touching the patient — whether it’s a handshake, a gesture of comfort or part of a physical exam — makes a difference, too.
And the old art of good conversation never goes out of style: Ask open-ended questions, like, “How are you feeling today?”
The hospital where I get much of my care, one of the world’s great research hospitals, has recently been extending its medical record system which is now directly used by the providing professionals to input information. This has given me the opportunity to observe and discuss with some of my doctors the impact of these record keeping requirements. One told me of having had to stay till late at night to complete transcribing notes into the computer, until that doctor decided to give in and turn away from the patient to the computer during the interview. That doctor, I should note, did the right and transparent thing, and explained and apologized to me.) Another acknowledged how awkward it felt to have to turn away from me to the computer all the time.
The hospital, while installing computers in every consulting space, has apparently given little thought to where to place computers and desks. It would surely help to put doctor, patient, and computer into a physically triangular relationship, rather than require the doctor to turn to the wall, and away from the patient, but this is obviously only a partial solution. I am told that one of my doctors got so interested by the discussion about the medical record system that it ended up reported in the notes on my visit.
In the long term voice recognition and maybe intelligent software that will know what needs to be recorded and what does not may help solve the problem — personally I would love to be given a link to video of the interviews with my doctors (more for the NSA to chew over) to help me understand what the doctor has been saying.
But in the short term we have to do all we can to use the data system to enhance rather than undercut our relationships with our patients/clients, depending on the profession. Showing the client/patient what is on the screen will help, and placing the computer so that doing so is easy facilitates part of the solution.
More ideas, anyone?
Great post. Very interesting.
That’s good. There was a study some years ago where the doctor patient interaction was video-taped and the tapes analyzed. Their was another where – well, enough. The subject is important and, I think, fascinating.