Pencils and paper ready!

 

No, this isn’t a test, this is an admonishment. For years, I have been using these letters to vent my frustration with the federal government and practice administrators who have foisted several generations of user-unfriendly electronic health records on us. Maybe it’s time to accept the ugly fact that, for the near future, clunky and time-gobbling EHRs are the reality, and we need to think of strategies to make the best of a bad situation.

It’s not only physicians who are complaining about EHRs. Listen to your friends and relatives at cookouts and in the line at the grocery story. You’ve heard what they are saying about us. “He always has his eyes on the computer screen. Never looks at me, and I’m not sure he’s listening.” “She asks me the same questions the nurse and that other woman already asked me. Hasn’t she already looked at my chart?” If you haven’t heard those complaints, make an appointment to see a doctor and experience the distortion of the doctor-patient interaction that the computer has created.

I have a less than modest proposal, based to some extent on the last several years that I practiced office pediatrics. How about we put ourselves on a screen diet? Don’t you think that you could see most of the patients without referring to a computer in the examining room?

It might take some reordering of how you do things. Take a look at the patient’s chart before you go in to see the patient. Many of you may do this already. It’s the courteous thing to do. In the few cases you don’t think you can trust your memory on the trip between your office computer and the exam room, scribble a few notes on a scrap of paper.

Ask the patient to repeat his chief complaint; it may have a completely different ring to it than the one the nurse/receptionist entered in the computer. Apologize to the patient for asking the history again. Or even better, why not be the first and only person to take the history? Scribble a few more notes and a few more after the physical exam if necessary.

At the end of the visit, return to your office to order any lab work and prescriptions the visit required. Take a few minutes to look at the next patient’s medical record and then repeat, repeat. I have found that, in a general pediatric practice, when I was busy, I could batch three, rarely four, patients together before returning to my desk for a more lengthy sit down to finalize the charts, sometimes using my few scribbled notes to jog my memory.

I am confident that most of you are capable of the same mental gymnastics. You’ve passed the MCAT, graduated from medical school, passed the state board, and probably your specialty boards. You should be the master of retention. If a skilled wait person at a good restaurant can keep four patrons’ orders in his/her head, you should be able to retain the basic clinical information on a couple of patients with the help of a pencil and paper. The reward for your mental effort will be dramatically improved doctor-patient interaction. The patients will be impressed that you are looking at and listening to them, and not a computer screen. You will get more and better information from them, and this will make for more accurate diagnoses and better targeted therapies.

If you can’t imagine this working because your office system demands that a diagnosis and billing code be entered before that patient checks out, it may be time to demand a scribe.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including “How to Say No to Your Toddler.” Email him at [email protected] .

 

No, this isn’t a test, this is an admonishment. For years, I have been using these letters to vent my frustration with the federal government and practice administrators who have foisted several generations of user-unfriendly electronic health records on us. Maybe it’s time to accept the ugly fact that, for the near future, clunky and time-gobbling EHRs are the reality, and we need to think of strategies to make the best of a bad situation.

It’s not only physicians who are complaining about EHRs. Listen to your friends and relatives at cookouts and in the line at the grocery story. You’ve heard what they are saying about us. “He always has his eyes on the computer screen. Never looks at me, and I’m not sure he’s listening.” “She asks me the same questions the nurse and that other woman already asked me. Hasn’t she already looked at my chart?” If you haven’t heard those complaints, make an appointment to see a doctor and experience the distortion of the doctor-patient interaction that the computer has created.

I have a less than modest proposal, based to some extent on the last several years that I practiced office pediatrics. How about we put ourselves on a screen diet? Don’t you think that you could see most of the patients without referring to a computer in the examining room?

It might take some reordering of how you do things. Take a look at the patient’s chart before you go in to see the patient. Many of you may do this already. It’s the courteous thing to do. In the few cases you don’t think you can trust your memory on the trip between your office computer and the exam room, scribble a few notes on a scrap of paper.

Ask the patient to repeat his chief complaint; it may have a completely different ring to it than the one the nurse/receptionist entered in the computer. Apologize to the patient for asking the history again. Or even better, why not be the first and only person to take the history? Scribble a few more notes and a few more after the physical exam if necessary.

At the end of the visit, return to your office to order any lab work and prescriptions the visit required. Take a few minutes to look at the next patient’s medical record and then repeat, repeat. I have found that, in a general pediatric practice, when I was busy, I could batch three, rarely four, patients together before returning to my desk for a more lengthy sit down to finalize the charts, sometimes using my few scribbled notes to jog my memory.

I am confident that most of you are capable of the same mental gymnastics. You’ve passed the MCAT, graduated from medical school, passed the state board, and probably your specialty boards. You should be the master of retention. If a skilled wait person at a good restaurant can keep four patrons’ orders in his/her head, you should be able to retain the basic clinical information on a couple of patients with the help of a pencil and paper. The reward for your mental effort will be dramatically improved doctor-patient interaction. The patients will be impressed that you are looking at and listening to them, and not a computer screen. You will get more and better information from them, and this will make for more accurate diagnoses and better targeted therapies.

If you can’t imagine this working because your office system demands that a diagnosis and billing code be entered before that patient checks out, it may be time to demand a scribe.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including “How to Say No to Your Toddler.” Email him at [email protected] .

 

No, this isn’t a test, this is an admonishment. For years, I have been using these letters to vent my frustration with the federal government and practice administrators who have foisted several generations of user-unfriendly electronic health records on us. Maybe it’s time to accept the ugly fact that, for the near future, clunky and time-gobbling EHRs are the reality, and we need to think of strategies to make the best of a bad situation.

It’s not only physicians who are complaining about EHRs. Listen to your friends and relatives at cookouts and in the line at the grocery story. You’ve heard what they are saying about us. “He always has his eyes on the computer screen. Never looks at me, and I’m not sure he’s listening.” “She asks me the same questions the nurse and that other woman already asked me. Hasn’t she already looked at my chart?” If you haven’t heard those complaints, make an appointment to see a doctor and experience the distortion of the doctor-patient interaction that the computer has created.

I have a less than modest proposal, based to some extent on the last several years that I practiced office pediatrics. How about we put ourselves on a screen diet? Don’t you think that you could see most of the patients without referring to a computer in the examining room?

It might take some reordering of how you do things. Take a look at the patient’s chart before you go in to see the patient. Many of you may do this already. It’s the courteous thing to do. In the few cases you don’t think you can trust your memory on the trip between your office computer and the exam room, scribble a few notes on a scrap of paper.

Ask the patient to repeat his chief complaint; it may have a completely different ring to it than the one the nurse/receptionist entered in the computer. Apologize to the patient for asking the history again. Or even better, why not be the first and only person to take the history? Scribble a few more notes and a few more after the physical exam if necessary.

At the end of the visit, return to your office to order any lab work and prescriptions the visit required. Take a few minutes to look at the next patient’s medical record and then repeat, repeat. I have found that, in a general pediatric practice, when I was busy, I could batch three, rarely four, patients together before returning to my desk for a more lengthy sit down to finalize the charts, sometimes using my few scribbled notes to jog my memory.

I am confident that most of you are capable of the same mental gymnastics. You’ve passed the MCAT, graduated from medical school, passed the state board, and probably your specialty boards. You should be the master of retention. If a skilled wait person at a good restaurant can keep four patrons’ orders in his/her head, you should be able to retain the basic clinical information on a couple of patients with the help of a pencil and paper. The reward for your mental effort will be dramatically improved doctor-patient interaction. The patients will be impressed that you are looking at and listening to them, and not a computer screen. You will get more and better information from them, and this will make for more accurate diagnoses and better targeted therapies.

If you can’t imagine this working because your office system demands that a diagnosis and billing code be entered before that patient checks out, it may be time to demand a scribe.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics including “How to Say No to Your Toddler.” Email him at [email protected] .