We’re watching you…
Me: I love this electronic health record! All of my information is in one place.
Also me: Why doesn’t my doctor ever look up from the screen?
Writing this issue’s feature on electronic health records made me think back on physician behavior around technology that I have observed. There’s my allergist, who only asks questions prompted by the EHR and types away the whole time I’m answering. There’s the orthopedist who breezes in the room, shows me the relevant images on a screen, and then whisks away in a practice that I know boasts about its efficient patient visits. I assume his total lack of charting means he dictates notes that some unseen transcriptionist will put into the record later.
The one who gets it most close to correct is my children’s pediatrician. She sets her laptop down and after a quick hello, glances over the computer screen to look at the problem list or touch base on vaccinations or screenings that are needed. Then she shuts the laptop and we have her full attention for the exam and discussion. Then she’s back at the screen checking off lists and typing notes. This is the imperfect portion of the visit, where I sit there awkwardly, unsure of the correct etiquette. Is it acceptable to chat with the kids? Check my phone? What are patients supposed to do during the typing time?
I found few solutions in talking with faculty and other stakeholders who are experiencing the pleasure and the pain of EHRs. I hate to imagine any of the doctors in my life charting at home, taking time from people or activities they love. In this imperfect system where clunky technology, external regulations, and diversified insurers make the EHR agonizing, physicians have no choice but to find their own style for getting the work done.
But as you do that, know that your patients are observing you. They want your undivided time and attention. Whatever style you adopt, look at it from your patient’s angle. You don’t want to see the back of your own head.