Readers speak about computing in front of patients

Posted on May 7, 2012 I Written By

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

A couple of readers did me the honor of commenting on other boards about my last post on whether or not to compute in front of patients, and so I thought I would add a new post showing my appreciation to them for their insightful comments and adding a few of my own thoughts.

Patrick Howard wrote:
“It’s all about educating the patient. If the patient understood what you can do with the technology (flowsheets, care coordination, etc.) then they would insist on the use of EHR’s.”

Many of my patients are so glad that everything is documented clearly in a modern electronic record and have told me so. The feeling I get from them is that they are relieved to be in a practice that keeps up to date with technology, and I do think they equate this with better care (whether this is true or only perceived as true).

Patrick also wrote, “…you can also deflect some of this just by putting a sign in the waiting room, explaining why we are now using electronic charts and what it means to your care. 
Again, it’s about educating!!!”

This is a good thought for a proactive action plan. In my post, I had commented on how patient complaints about the EHR were very rare. If this starts to happen more frequently, then I may do just as Patrick suggested and make an alert sign.

Dr. Tim Thurston wrote:

“I read and enjoy your blog regularly. I am a pediatrician and we have been on EHR for over 5 years. I do all my documentation in the room face to face with the patient/parent including sending the eRx. I basically talk to them what I am typing which reinforces my findings and recommendations. I can then reinforce what I have said by handing them a personal plan that I typed while in the room. During the actual physical exam the laptop is out of the way which offers plenty of time to discuss without the barrier of the computer screen.”

Why thank you Dr. Thurston! I appreciate all of my readers, especially those who care enough to give me the gift of their comments.

As far as documenting while speaking, I have done this a fair amount as well, but not for each encounter. When I do it, I often speak slowly as I am typing so that the patient hears my thoughts again for reinforcement. I even remember a patient commenting on how he enjoyed knowing exactly what I was writing in his chart. Often, patients have a conversation with their doctor and the doctor ends up writing something that the patient later disputes as inaccurate after gaining access their chart notes. Once it’s in the notes and they’re signed, there’s no erasing, only addending. I find that getting the all right the first time is actually cleaner and less of a hassle later.

“It is here to stay and we as docs just need to find ways such as you often mention in your column to continue to make it more friendly to the patient.”

Yes, I love my EMR system and it will stay with me.  I  think that in the future, though, the technology will become more efficient and creative and allow us as physicians to get back to spending more time thinking about and talking with our patients.