How an EMR gets in the way of doctor-patient relationships

Posted on July 16, 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

For all of the glorification of EMRs and EHRs and pushing into the new age of digital healthcare, I thought I would throw in my 2 cents from the dark side of electronic health record keeping.  To be honest, there are a few things that could be greatly improved.

Now, before I get a whole bunch of unsolicited email from EMR vendors out there waiting to pounce on me with sales pitches of how theirs is better and I should give it a try, I should say that I’m very happy with my current EMR system and not looking to switch.

That notwithstanding, there are a few simple concepts that no EMR system to my knowledge has gotten right yet.  It’s even possible that it may be hard to ever get right, and a lot of it has to do with mouse clicks and typing.

During my average day, I feel the need to maintain at least some eye contact with my patients, mostly because I’m a bit uncomfortable with the amount of time I have to spend looking at my computer.  I’m a bit of a slave to the computer system in that sense.  I know I could do all of the documentation after the patient is gone, but I’m afraid of missing something in the documentation.  You could say I could just scratch notes on paper to avoid missing anything, but this is not in keeping with the lofty goal of being paperless, now is it?  Maybe the lofty point is just to eliminate paper charts.  Still, scraps of paper doesn’t really sound modern or safe now, does it?

I also feel a bit uncomfortable giving up my nights and weekends just to “look good” in front of my patients.  A burned out doctor who has no life outside the office to spend with family and friends, and who ultimately quits the profession because of such, is not an ethical thing to expect of physicians, is it?

And so, for now, I do my best to incorporate a bit of eye contact, but still spend time typing away with the patient across my desk watching me and telling me about their issues.

The EMR still requires a lot of additional tasks outside of documentation: electronic prescribing, reviewing messages from staff and performing additional tasks as necessitated by these messages.  And all of these tasks take a considerable amount of time.  Up until now, they have required human intervention to complete, but what about the future?

One of my recent hobbies is reading history texts.  Interestingly, one of the stimuli that encouraged the Europeans to seek an alternative passage to the Far East was the excessive trading fees imposed by transmitting goods through Muslim and African nations.  An alternative route that would allow the elimination of hefty fees and allow them to run their import-export businesses cheaper and more efficiently was the dream.

If we can automate all of the EMR tasks more effectively using a Siri-like voice-activated platform, then medical providers may be able to achieve all of their work during normal business operating hours, face the patients when they speak, and have a better quality of work and home life than their predecessors.  I’d love to be able to tell my computer to send in a scrip refill for thyroid hormone and it would be done, without the need for any other steps or human involvement, but that remains a far off mirage at this point.

The more an EMR can do for me, the more time I can spend in humanistic and meaningful contact with patients.  I dream of actually living the dream but for now live in the reality of a less than perfect world.