Dr. Nancy Tice on the downside of practicing medicine through a screen:
[E]ven skilled physicians commonly display troubling behaviors, such as spending too much time looking at the computer monitor, typing while patients are talking about intimate concerns, reading silently from the monitor, using templates to lead interviewing rather than listening to patient narratives, and turning their backs to patients in spite of mobile computer monitors.
Dr. Tice’s criticism is well taken. My original office building had poorly designed exam rooms where the desks were positioned so that the physician was pretty much obligated to turn his or her back to the patient while entering data.
On the other hand, the contemporary medical record — electronic or paper — is no longer just an account of symptoms, allergies, diagnoses, and treatments. In addition to this traditional role, the modern medical record has been pressed into service as third party payor billing invoice and medicolegal defense document. In fact, much of the necessity — real or imagined — for electronic medical records is a direct result of these comparatively new uses for patient records which are only peripherally related to diagnosing and treating disease.
One wonders if listening to the patient, making frequent eye contact, and picking up on non-verbal communication cues such as body language will become compromised by the element of impersonality that EMRs sometimes introduce into the patient visit. Both the third party payor system and our absurd legal system add substantially to the cost of health care, and not all of those costs can be tabulated in dollars and cents.