Something’s Happened to the Doctor Patient Relationship

by E. Steven Lenger, M.D.

 

The doctor / patient relationship is one predicated on trust. In any relationship, a certain degree of trust is eroded when  one feels that the other isn’t 100% present during a conversation. The doctor / patient relationship is no different and suffers when the inputting of EMR (electronic medical records) seems to take precedence over communicating directly to the patient.

Making eye contact, observing body language, and focused listening are crucial components to the history taking and even the physical exam. Picking up on the nuances communicated non-verbally is important in determining what is wrong even before ordering the myriad of tests necessary for a diagnosis. For example, when examining the abdomen for signs of pain, I would be sure to look at the patient’s face while asking questions, because sometimes a patient’s “no that doesn’t hurt” is contradicted by a change in facial expression.

Unfortunately, we have become a society umbilically attached to smartphones. Conversations suffer when one or more of the participants is only half listening, the other half reading a text message. This degradation of social interaction has carried over to the exam room.

Although EMR (electronic medical records) has enabled doctors to document patient encounters in great detail, it comes at the expense of lessening the personal relationship so important in medicine. Patients are often worried and anxious, and I believe this double edge sword of a technological development has potential to exacerbate the anxiety.

Doctors now spend too much time during visits typing the history and physical findings and not enough time actually talking to the patient and his or her family.  

An article recently published in the Annals of Family Medicine (October 18, 2017) revealed that primary care physicians spend more than half their workday inputting information into the EMR system. How many of us have been to a doctor only to watch them type into a computer or tablet for most of the visit? What we may not tolerate at the dinner table, we accept in the doctor’s office.

Although the EMR system is mandated and useful in documenting the doctor patient encounter, it comes at an expense. Some offices actually hire a scribe to document the visit so that the physician is not looking into a screen while talking to the patient. Unfortunately, this is not something available to most practices.  Another option might be to have all visits recorded and the physician or a scribe can then input information into the EMR system. Again however, this is only adding more time to the doctor’s busy schedule.

There is no clear or easy answer to this issue, but unless a solution is found and universally accepted and used, I fear that one of the most basic skills we are taught in medical school, taking a thorough and comprehensive patient history, may be lost.