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Digital Doctors and E-Patients of the 21st Century

Shira Yehudit Djlilmand

In today’s digital age, when technology has removed the “personal” from interpersonal communication, virtually every job description has undergone redefinition. In the medical field, the classic family physician has given way to the “digital doctor” and the trusting patient has morphed into a well-informed, discriminating “e-patient” — with ramifications for the people, the system, and the very nature of health care.

Wednesday, June 01, 2011

Not so very long ago, the image of a doctor was of a kindly old man who had time to sit and listen to his patients’ troubles and even remember the children by name. But today, that image is steadily being replaced by the picture of an overloaded young physician hidden behind his computer, typing out a list of diagnostic tests. One of the major causes of this change is the Electronic Medical Records (EMR) System. In the US, President Obama’s healthcare plan calls for the computerization of all medical records within five years. In Israel, the majority of health care providers have already made the transition from bulky cardboard medical files to computerized records.

One major benefit of the EMR system is the ease and speed of access to crucial patient information. “EMR is tremendously important,” says Dr. Yitzchak Stern, a family practitioner in Tzfas, Israel, with over thirty years experience. “Before, when everything was handwritten, you could be looking for an important document — is it in the file? Yes? No? Did you actually write it? Yes? No? Now everything is there where you need it. Even something from ten years ago can be found in seconds.”

During short appointments, that speedy access allows doctors to actually connect with the patient instead of hunting for elusive records. “We don’t have to ask so many questions now, since all the information is at our fingertips,” says Dr. Stern. “It definitely saves us time during appointments.”

Such clear records can also help the doctor determine the most appropriate treatment for the patient, as they can bring up a list of past illnesses and detect patterns that may help them reach a diagnosis.

Still, electronic records can occasionally contain mistakes, and it’s unclear who is better equipped to address those mistakes. “The government thinks that patients are the answer — they are the ones who will know if there is a mistake,” says Professor Ethan Katsh, director of the National Center for Technology and Dispute Resolution. But not every physician is comfortable allowing their patients to access and edit their records. “Patients never had access to their records before, and that can cause stress in the relationship between doctor and patient.”

From the patients’ perspective, the digitalization of medical information is often blamed for causing a disconnect between doctor and patient, a physical and mental barrier of sorts. Before the system’s debut, doctors had the same fears, Dr. Stern confesses. “The transition period to digital records was difficult. I’d been in medicine twenty years and then suddenly, everything had to be computerized. Like most doctors, I was worried that I wouldn’t have enough time to talk to my patients.” To make sure that he did indeed have time to talk to his patients, Dr. Stern sacrificed his evenings to update his computer files, until he became more fluent with the computer and was able to input the information during actual appointments.

But not every doctor goes to such lengths to preserve doctor/patient relations — and some patients feel that their input is secondary to the computer in the room. As Dr. Danny Sands, founding co-chair for the Society for Participatory Medicine, points out, “It’s all too easy to order another test instead of just listening to the patient.”

With the right attitude, the intimidating barrier of the computer can be overcome. Dr. Stern made great efforts to ensure that the computer sitting on his desk does not come between him and his patients — literally. “When we got our first computers, they were huge. Most doctors put them on the desk, where they made a mechitzah between doctor and patient, but I had a special corner built so that the computer was off to the side and the patient could see me. Now of course we have flat screens, but to be honest, the point is, with or without computers some doctors have the same problem — their head is always in the files.”


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