By Sharla Hooper
“[The] humanistic element of doctor/patient relationship has failed to keep up with technological advances in all aspects of medicine.” James H. Reifschneider, MD
Earlier this month, our organizations surveyed members on the topic of technology in medicine. Technology has permeated our modern lives completely, and is seen as both an innovative asset and an encroachment in medicine. The survey allowed us to look at opinions on a broad range of technology aspects in medicine. Several respondents specifically cited the burdensome cost of electronic medical records (EMR), and we also saw concerns about how EMR specifically has impacted the doctor-patient relationship.
The alphabet soup of federal requirements and measures have generated concern about the impact on patient care as well as individual physician burnout. According to Dr. Mark Friedman, “EHR and CMS have horribly abused and misused the potential role of technology in the delivery and documentation of health care. We now spend most of our time complying with statistical nonsense, whether on paper or on screen.”
Another physician pointed out the inefficiencies in time spent on EMR charting: “I feel that “inputting” data into the EMR has increased time spent with data entry. Surely there’s a better way.” A recent analysis of physician time found that for every one hour of patient care, physicians spend almost two hours with EMR documentation and other desk work. The respondents’ comments reflect the frustration with this status quo. “I think it is ridiculous that for every hour spent with a patient, two hours are spent in the EHR. Physicans need to be liberated from the mountain of documentation demands/clicks so we can care for patients,” stated Dr. Kevin Moynahan.
Of our respondents, 43.1% feel that using an EMR has eroded their relationships with patients; 13.7% feel it has enhanced their relationships. Asked to identify whether EMR has an impact on the care physicians deliver, 33.3% feel it has impaired care, while 31.3% feel it has improved care. Dr. John Boyer shared that “electronic record keeping…during interviews with patients has cooled what once was the best part of the Doctor-patient relationship.”
And patients share their frustrations as well, as Dr. Dennis Cooper describes: “Patients complain the physician is so busy keeping computer happy that they don’t make eye contact. They also state physicians are so over extended that they hardly ever see the physicians and are relegated to mid-level staff instead.”
Asking about the impact of technology on patient ‘self-diagnosis’ (i.e. checking WebMD) revealed aspects of how different physicians manage this issue in their practice. While 25.7% of respondents found that patients’ online research “has improved my ability to practice, as my patients are more informed of their condition and treatment options,” another 28.7% of respondents found it more difficult. Self-diagnosis to can lead to unnecessary testing, and direct to consumer advertising was cited as pervasive and problematic.
Dr. William Nevin: Patients have sought advice from incorrect web sites leading to requests for inappropriate investigations. Adverse outcomes have been avoided via counseling and redirection. The direct to [consumer] advertising of drugs has led to inappropriately increased costs with no improvement in outcome. The drug manufacturers are more skilled at advising patients through TV than I am at suggesting that the new stuff is definitely more expensive but probably not more dangerous…
Dr. Julie Wendt: In medical school, before training, physicians actually saw real patients and developed a sense of normal v. abnormal; there was a phenomenon in which many students, after reading accounts of various disease states, thought they had them. That is, until they saw what abnormal really looked like. I see the same situation occurring with patients, they read or are told about an issue and feel they have it. If I didn’t test…it would erode our relationship. When I do, it makes medicine more costly. For these and other reasons, I truly feel direct to consumer advertising should be abolished.
Patient research can lead to helpful discussions in some cases.
Dr. Robert Brown: The use of online forums, especially for specific diseases, has allowed greater understanding of management by the patient but has also caused confusion as to why treatment differs from patient to patient. Addressing the use of these forums and creating better education for the patients will be necessary in this world of increased online resources.
Dr. Rex Ragsdale: I welcome patient’s investigating health information on the web. Ironically, because much of it is incorrect, it gives me an opportunity to address the issues they raise and improve the increased impact of the discussion.
The survey reflects both insights and the limitations of gathering opinions on the multivalent impact of technology in the practice of medicine. As one respondent pointed out, to “pretty much every question in this survey…the real answer is almost always ‘it depends.’”
Physicians overwhelmingly responded that increased technology should NOT be made available directly to patients without physician determination or referral. One physician clarified, “if they order tests and they are abnormal I cannot be responsible for monitoring. I hope that is clear in the law. I do not see this as a technology issue – but a patient being able to get lab work done issue.”
The law referred to specifically is HB2645, and one of the features of the law that organized medicine was able to secure was removing liability burden from the physician, who would have no way to know of a patient’s self-referred lab test.