Clinical Accuracy and the Human Connection: EMRs, Patient Face Time & Bedside Manner

Clinical Accuracy and the Human Connection: EMRs, Patient Face Time & Bedside Manner


We all know the scene – you’re sitting around to eat, whether with friends, family, or colleagues in the break room – and everyone is staring at the nearest digital screen, and normally the one in their hands. Even when there is minimal conversation occurring amongst the people in this situation, no one is engaging with one another. Everyone is heads down, in their own little social media universe, or crushing candies like a mad man. Even on those occasions when a group of people are engaging with one another, and one person goes heads down to look up something relevant to the conversation, it’s hard not to feel a little bit like they’ve unplugged from the rest of the group. So how does that reality impact the quality and feel of our healthcare, now that EMRs are the standard practice and there’s a digital device in the hands of every provider?

A recent study published by the US National Library of Medicine National Institutes of Health found that physicians spend around 35% of their time documenting patient data and implementation of a structured and standardized EHR was associated with 8.5% decrease in time for dedicated patient care during consultations in one center and 8.3% increase in dedicated documentation time in another center. The graphic above, published in a Society of Teachers of Family Medicine Journal study, shows that primary care physicians spent more time working in the EHR than they spent in face-to-face time with patients in clinic visits.

Now, in all fairness, I have experienced both sides of this coin during visits to my personal health care practitioners. I’ve had the pleasure of seeing providers who will do a quick validation of information in the EMR, and then shut the laptop or set down the iPad so that they can look me in the eye and we can have a real, engaging conversation. I’ve also had the misfortune of seeing providers who will spend the entire visit with their eyes locked on the screen in front of them, barely looking up to acknowledge that there is a human being sitting across the room answering their questions. These two types of encounters have left me feeling quite conflicted about the true benefits of EMRs when it comes to patient care.

Obviously, there are boundless advantages that the advent of EMR technology has provided us – continuity of care, drug interaction and allergy alerts, transference of clinical, imaging and lab data, as well as more comprehensive scheduling and patient ownership of data – just to name a few. And of course, each one of those things (and a plethora of additional things I left unmentioned) are critical to the quality of care that health care providers are able to administer to their patients, not only to ensure patient safety, but also to allow providers to get the most complete picture of a patient’s care plan and individual history so that they can provide the appropriate recommendations and treatment plans going forward. But I have to wonder – is the embrace of this fundamental health care technology causing a disconnect between provider and patient?

Opinions here may vary, but I personally have always felt that I received more comprehensive care and guidance from those medical providers who took the time to look me in the eye, and get to know on some level who I am as an individual. I feel that it allowed them to see beyond the chart – that is, to understand my personal situation and the impact that whatever ailment I was being seen for had on my day-to-day life, and could have on my future. This lead to a clear and thorough discussion of my options, and to myself and the provider coming to an agreement about the best care plan for me as an individual. For example, when selecting a medication, I truly appreciated the Nurse Practitioner who took the time to review all available medications, and ask me about my priorities in life: Did I have any experience, positive or negative, with any of this type of medication in the past? Was I trying to lose weight, gain weight, or maintain? How prone had I been to side effects of other medications I had taken before? This allowed him to make a recommendation that he knew would not only treat my ailment, but would most likely avoid any unpleasant side effects that could cause me further challenges in the future.

On the flip side of the coin, when I’ve engaged with a provider who spent the entire visit hiding behind the screen, I felt as if I was nothing more than a list of values in a chart – like a textbook case of whatever I was there to address – and like the nuance of my specific experience was irrelevant when selecting a treatment plan. I left those visits feeling like I could’ve done myself just as much good had I signed on to WebMD or Google and gotten my own diagnosis, and that the only differentiating factor was that he had a larger volume of potential medications than I could find down at my local pharmacy.

Whether you are reading this from the role of patient, provider, EMR administrator or healthcare IT professional, I encourage you to think about the value of the human connection in healthcare today and what it means to you. Yes, a provider who stares at a screen throughout a visit can perhaps provide the same treatment options as a provider who engages with their patients on an individual level – but is the level and quality of care truly the same, regardless of the human connection?

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