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John Whyte, M.D., MPH

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'Look at Me, Doc'

Posted: 11/30/2011 5:03 pm

I'll be honest -- I like technology and gadgets! When used correctly, they certainly can improve medical care. For the past 15 years of providing clinical care, I have often used an electronic health record when interacting with patients. Since I often fill in for doctors in under-served areas, the electronic health record provides me a wealth of information about the patient I'm about to see -- literally at my fingertips. I make it a point to review the patient's history, medications, diagnostic tests, clinical notes -- all before I see the patient. That way, I can spend quality time with the patient discussing their symptoms and examining him/her.

Unfortunately, it doesn't always seem to work quite that way. In the past two years, a large number of doctor's offices have been converting to electronic health records. In the long run, this is a very good thing since we'll be able to get more data about patients and populations -- which ultimately will lead to better care. Unfortunately, I think that in the short run, there have been some problems. Take for instance a recent example my mother experienced. I accompanied my mother to her recent doctor's appointment, and to both of our dismay, the doctor looked at the computer screen nearly the entire visit -- all 12 minutes of it. She barely looked at my mother; there was a very brief and limited exam. It was basically "type, type, type." My mother left very unsatisfied with the visit.

Quite frankly, I was shocked as well. Technology is supposed to enhance the physician-patient relationship. Health information technology certainly has the potential to make the healthcare system more patient-centered. This includes not only electronic health records, but also telemedicine and remote monitoring. Sometimes, however, hiccups occur along the way.

I think patients need to speak up. I understand there is a learning curve for new technology -- but physicians should not waste patients' time figuring it out. If your doctor is simply spending time looking at a computer screen either in front of him or in his hand, politely ask him to put it down. You're there to talk to a real-life person. And I always learn a lot by observing the patient -- how she walks into the office, or how he talks or grimaces during an exam. There are important non-verbal clues to disease -- but if I'm looking at a computer screen, I'm going to miss these important clues.

Don't get me wrong -- electronic health records are a good thing. There is data to show that the use of this technology reduces error. And I know for a fact it helps ensure better patient care when patients move from the hospital back to an outpatient setting -- times of transition are often periods where information is miscommunicated. And I encourage patients to access their health records to make sure they are accurate, as well as to become more involved in their care. Surprisingy, very few patients do. In a recent survey, the majority of U.S. adults have not accessed their records, nor do they have an interest in doing so. This is a lost opportunity since the medical community will now be relying on these records, and you need to help make sure they are 100 percent accurate. Ask your doctor as well as your insurer as to how to access your medical information online.