Meeker: Technology distracting doctors from diagnosis

I applaud new legislation to outlaw “texting” while driving. In my 16 years as county medical examiner, my files contain several photos of decedents behind the crashed wheel still clutching the smart phone. The device diverts attention from the task of driving.

Why, then, do we want to tolerate our physicians texting while examining a patient?

Many area practices have joined the race to have the latest and best electronic medical record system. Virtually all of the specialty clinics have them. The days are gone when we primary care physicians receive the thoughtful and concise consultation letter from a specialist. We now get computer-generated letters put together from the templates of data contained in the system. This paper, usually generated in triplicate, is worthless.

Recently, I was listening to my patient lament the “terrible” experience she had in the specialist's office. “They did not give me any time” was the complaint, “a total waste of time.”

“Wait a minute,” I said, springing to my colleague's defense. “You had a very complete evaluation, I have the five-page document right here!”

“Read some of it to me,” she said.

As I began to read the document, systematically organized beginning with the “chief complaint” followed by detailed history reviews, multiple system reviews, and a thorough examination, the patient was aghast that her medical record was a complete work of fiction.

“He didn't say or do any of that while I was there,” she said. “He just sat there and typed.”

Welcome, ladies and gentlemen, to our new electronic medical record system. Roll over Hippocrates and Osler.

This patient, as well as countless others, describe these “consultations” as spending over an hour in the reception area filling out a very detailed questionnaire. The actual visit that follows, I have been informed, usually consists of these physicians, most not keyboard competent, spending 13 minutes of the 15-minute encounter entering data from the questionnaire into their templates. Several patients have insisted they were never examined at all.

The electronic medical record, like all other computer functions, suffers greatly from “garbage in - garbage out.” We now have seasoned and experienced practitioners focused on keyboards, completely obscuring their experienced senses of observation and communication.

Most family physicians know that in a majority of cases, the patient will give you the diagnosis, if you just look and listen. But sadly, we must focus on these screens and templates much like the Midas 50-point safety inspection.

I like my technology. My patients are accustomed to seeing me pulling out either my blackberry or palm to check an electronic reference.

But the system I like involves eye contact and conversation, the allotted time roughly split between history-taking and physical examination. Then comes more, the thinking about the complex case at night, researching literature, and reviewing labs and results as they come in.

The typing, though, I delegate to our transcription department; they need jobs too.

But alas, we continue to interview electronic medical record representatives, as we know resistance is futile. The all-important “art” of medicine is being replaced by templates and checklists that produce pretty (but fictional) documents.

Lawmakers have assembled all sorts of panels of “experts” who have them believing all the disease can be prevented if we get everybody to fit onto these electronic templates. The experts do not take care of patients. If they did, they would not have the time to be giving all this bad advice.

Perhaps the ideal system is out there. I haven't seen it yet. I will keep looking.

At least for the short-term, the laptops stay in my office and not in the exam room as a distraction.

Dr. Brian Meeker has been medical director for Virginia Gay Hospitals & Clinics in Vinton and Benton County medical examiner for 16 years.