{"id":4897,"date":"2014-02-05T21:04:19","date_gmt":"2014-02-06T02:04:19","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=4897"},"modified":"2015-06-04T14:32:34","modified_gmt":"2015-06-04T18:32:34","slug":"electronic-medical-records-eye-contact-and-dogs","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/electronic-medical-records-eye-contact-and-dogs\/2014\/02\/05\/","title":{"rendered":"Electronic Medical Records, Eye Contact &#8212; and Dogs"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2014\/02\/Louie-looking-at-you1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright  wp-image-4940\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2014\/02\/Louie-looking-at-you1.jpg\" alt=\"Louie looking at you\" width=\"197\" height=\"194\" \/><\/a>A few thoughts on the importance of eye contact during patient care, no doubt inspired by my puppy&#8217;s first birthday, and his insistent and adoring (at least that&#8217;s how I see it) gaze:<\/p>\n<ul>\n<li>Long piece in the <em>New York Review of Books<\/em> &#8212; all doctors subscribe, of course &#8212; by Arnold (Bud) Relman, <strong><a href=\"http:\/\/www.nybooks.com\/articles\/archives\/2014\/feb\/06\/on-breaking-ones-neck\/\" target=\"_blank\">describing his experience as a 90-year-old who survives a fall.<\/a> <\/strong>Riveting, moving, and typically curmudgeonly stuff from the ex-Editor-in-Chief of the <em>New England Journal of Medicine<\/em>. But this line deserves emphasis: \u00a0&#8220;During the day I was visited on rounds by teams of physicians. They spent most of their time outside my room, <em>studying and discussing the data on their mobile computers.<\/em>&#8220;<\/li>\n<li>How do interns spend their time in the era of electronic medical records? <strong><a href=\"http:\/\/link.springer.com\/article\/10.1007\/s11606-013-2376-6\" target=\"_blank\">Let&#8217;s look at the data<\/a><\/strong> &#8212; &#8220;Interns spent 12% of their time in direct patient care, 64% in indirect patient care, 15% in educational activities, and 9 % in miscellaneous activities.\u00a0<em>Computer use occupied 40% of interns\u2019 time.<\/em>&#8220;<\/li>\n<li>Or, for a more poetic description, read Abraham Verghese&#8217;s <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMp0807461\" target=\"_blank\"><strong>brilliant description of the &#8220;iPatient&#8221;<\/strong>:<\/a> \u00a0&#8220;On my first day as an attending physician in a new hospital, I found my house staff and students in the team room, <em>a snug bunker filled with glowing monitors &#8230; the demands of charting in the electronic medical record (EMR), moving patients through the system, and respecting work-hour limits led residents to spend an astonishing amount of time in front of the monitor.&#8221;<\/em><\/li>\n<li>One of my colleagues in General Medicine, Jeff Linder (who parenthetically <a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1745694\" target=\"_blank\">does some nice ID-related work too<\/a>), found that the number one barrier to use of electronic medical records during an outpatient visit was\u00a0<strong><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1839290\/\" target=\"_blank\">loss of eye contact with patients<\/a>\u00a0<\/strong> &#8212; which does not surprise me a bit.<\/li>\n<li>The solution? <strong><a href=\"http:\/\/www.nytimes.com\/2014\/01\/14\/health\/a-busy-doctors-right-hand-ever-ready-to-type.html?_r=0\" target=\"_blank\">Get a medical scribe to join you in the exam room<\/a>\u00a0<\/strong>so\u00a0you can actually look at the patient while taking the history.\u00a0This is the money quote from this wonderful <em>New York Times<\/em> piece: \u00a0&#8220;For decades, physicians pinned their hopes on computers to help them manage the overwhelming demands of office visits. Instead, electronic health records have become a disease in need of a cure, as physicians do their best to diagnose and treat patients <em>while continuously feeding the data-hungry computer<\/em>.&#8221; FYI, after reading this piece, every single colleague of mine wants a scribe <em>now.<\/em><\/li>\n<li>The hospital periodically receives patient surveys from <strong><a href=\"http:\/\/www.pressganey.com\/index.aspx\" target=\"_blank\">these guys<\/a>.<\/strong> The leading complaint, of course, is parking &#8212; this is Boston, after all. But in the Top Five Complaints is also something along the lines of, &#8220;That doctor seemed more interested in the computer than in me.&#8221;<\/li>\n<li>Department of Oversharing: \u00a0I recently saw a doctor for an eye issue, and he was very competent and nice. He spent 90% of the visit (aside from the exam part) entering what I was telling him into his electronic medical record. The computer was situated far to his left, so he was facing away from me the entire time; I could have put on <strong><a href=\"http:\/\/goo.gl\/SmDLbF\" target=\"_blank\">this hat<\/a>,<\/strong> he never would have noticed.<\/li>\n<\/ul>\n<p>OK, so I&#8217;m nearly done. Except to comment that we used to be able to take notes while facing our patients, and that this allowed a kind of organic eye contact that seems all but impossible in the electronic medical record era. Note that I won my 8th Grade Typing Competition (72 words\/minute, thank you), so don&#8217;t blame inadequate keyboarding skills.<\/p>\n<p>And since this started with a dog (dare you to click on the image above) and eye contact, I might as well say that they run rings around both cats and us electronic medical records-obsessed doctors when it comes to this skill.<\/p>\n<p>Enjoy more dog magic in this nifty documentary:<\/p>\n<p><center><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"\/\/www.youtube.com\/embed\/7t-s0q7Acyg\" frameborder=\"0\" allowfullscreen><\/iframe><\/center><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A few thoughts on the importance of eye contact during patient care, no doubt inspired by my puppy&#8217;s first birthday, and his insistent and adoring (at least that&#8217;s how I see it) gaze: Long piece in the New York Review of Books &#8212; all doctors subscribe, of course &#8212; by Arnold (Bud) Relman, describing his [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,7,8],"tags":[312,314,321],"class_list":["post-4897","post","type-post","status-publish","format-standard","hentry","category-health-care","category-misc","category-patient-care","tag-electronic-health-record","tag-electronic-medical-records","tag-emrs"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/4897","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=4897"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/4897\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=4897"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=4897"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=4897"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}