How to use all of your medical gadgets without forgetting about the patient in the room.
So, you have your smartphone in your pocket, loaded with medical apps, and you have your computer in front of you, housing the latest update of your EMR. You can quickly look up the next diagnostic step for elevated lab values, you can cross reference medication interactions with the Epocrates application, you can send e-prescriptions wirelessly to the pharmacy, and you can enter every detail from a medical encounter with the click of a mouse. The only thing these devices can’tdo... is talk to your patient. That is your job: to communicate with patients and help facilitate healing.
Patients drive hours, wait hours, and spend their money just to hear our advice. We should spend every minute of a patient encounter talking, listening, teaching, and bonding with our patients. Instead, we are busy trying to use our smartphones and our computers.
There is no doubt that the medical technological revolution is allowing medicine to be more accessible, but has the revolution also caused medicine to be more impersonal? As a medical student, I have had the ability to watch many physicians adopt EMRs and see how they try to balance the difficulty of recording everything on their computer, while still trying to include the patient in the process. I have witnessed multiple situations in which a patient clearly feels like the smartphone or computer was a complete interruption of the encounter, and their frustration was very evident. Because of this unique issue, I have outlined a sort of “etiquette” for using medical technology during patient encounters:
1. The most important first step in including a patient in the encounter is ensuring eye contact. Make sure that the computer is not placed against a wall, where you will have your back to the patient, and make sure that you are taking time to look up from your computer to make eye contact with the patient, especially when they are giving you the history of their problem. This would seem to be common sense, but I have seen enough physicians stay glued to their screen during the entire encounter that it bears mentioning.
2. Have extra power cordsat the desk in your office, at the nurse’s station, and in each of the patient rooms. When you enter each room, plug in your computer. Losing power during a patient encounter is distracting, embarrassing, and immediately stops you from continuing with the encounter. Again, I’ve seen it happen many times, and it is easily preventable.
3. Upon entering the room, explainto the patient that you may be using your smartphone to look up medications and using medical applications to help out with the diagnosis of their problem. If you do not make them aware of this, many patients will think that you are sending a text message. To take that a step further, responding to e-mails, text messages, or answering phone calls with your smartphone during a patient visit is widely considered to be very rude. If you have to take a call, excuse yourself and exit the room. Remember, it’s the patient’stime just as much as it is yourtime. Also, make sure to put your phone into the silentor vibratemode before you enter the room. You don’t want to be halfway through a physical exam when The Eye of the Tigerstarts blaring from your pocket!
4. If you have the ability to, use a tablet computer. Many tablets can run software that can easily interact with your EMR and e-presciption service. They can also run applications similar to your smartphone, which eliminates the need for switching between devices. Tablets also have applications that are unique to their larger screen, allowing for more interaction between you and your patient. Tablets typically have much better battery life than standard computers, eliminating the need to constantly plug them in, and avoiding loss of power during an encounter. Finally, some tablets are very light and portable, allowing you to sit next to your patient or place the tablet on the examination table and easily integrate the device into the encounter.
5. The most interactive way to use all of this new technology lies in the data-processing powerof these devices. Data is constantly being entered into the EMR, and that data can be manipulated and displayed in many ways. Most programs allow for a graph or some pictorial representation of this data, and we can use that to show our patients how they have been progressing. For instance, we take a blood pressure reading every visit. Why not use the program to display a line graph of how your patient’s blood pressure has changed since they began dieting and regularly exercising? This way, the patient can see their progress with their own eyes, and you can show your continued interest in the improvement of their health.
6. After the encounter is finished, place the computer and smartphone to the side and close the encounter by sitting in front of the patient and describing the plan of action with them, one on one. Patients truly respect that you have taken an extra second away from information gathering with the computer to make sure that they understand your plan.
Hopefully, these points will help you to approach the unique challenges that are presented with incorporating new technologies into interacting with patients. There is a happy medium that exists, but finding it can be frustrating and time consuming.
To borrow a few words:
Life is short, and art long;the crisis fleeting; experience perilous, and decision difficult.The physician must not only be prepared to do what is right himself,but also to make the patient, the attendants, and externals cooperate.~ First aphorism of Hippocratres, c. 400 BCE
Let us ensure that our modern technological externals continue to cooperate with our efforts to communicate and relate to our patients.
(Any feedback is greatly appreciated, thank you.)