My Eyes Are Up Here, Doc!


“My doctor spends my entire appointment staring at a computer screen!”

It’s a common complaint. Patients miss the days when going to the doctor involved actual eye contact with their physician, and patient satisfaction drops dramatically when there’s a computer screen competing for their doctor’s attention. Doctors hate it, too; studies show that the majority of physicians feel electronic medical records (EMRs) are more of a hindrance than a help. The average age of a practicing physician in the US is 52, and more than half graduated college before the internet existed. Now they’re being required to start using a computer for work they’ve done by hand for decades. And if that isn’t tough enough, they have to talk to patients at the same time.

If patients and doctors both hate EMRs so much, why do doctors continue to use them?

The short answer is “we have to.” The long answer is more complicated, and involves a tangle of government regulation, financial penalties, insurance lobbyists, and taxpayer money. Suffice it to say that EMRs aren’t going away any time soon.

My first job out of fellowship was with a community mental health clinic. They did not yet have an EMR,  and were still relying on paper charts. My handwriting fits every stereotypical joke about doctors’ illiterate scrawl, so I asked the medical director – a brilliant man who practiced medicine for more than sixty years – if I could type my patient notes instead of writing them by hand.

“I’m not certain about that, Dr. Miller,” he mused, leaning back in his desk chair. “I don’t believe we have a typewriter.”

Take a minute and let that one sink in. Then consider the fact that he had a computer sitting on his desk when he said it.

The following year, the federal government moved forward with the implementation of mandatory EMRs, and my medical director retired. Coincidence? Probably not.

A handful of strategies have been attempted to bridge the technology gap. Some doctors use dictation software to write their notes. This solves the problem with typing speed, but errors in syntax and grammar are frequent, and for those who struggle with technology, adding another software program to the mix just makes it more difficult. Others hire a scribe, the medical version of a court reporter, to complete the note for them. This absolves physicians of the need to learn the technology, but many patients don’t want a stranger of dubious medical training to be in the room during their pap smear or psychotherapy appointment.

Some enterprising genius decided that instead of making doctors type their notes, which tends to be agonizingly slow, they would instead create “templates” with a series of boxes doctors can check off to show whether symptoms are present or absent. Seems reasonable, right? Until you see it in action.

Look at this labyrinth of boxes.

One family practice physician who uses a check-box template told me she averages 100 clicks per appointment. Here’s the breakdown, which irritates her so much that she actually knew it off the top of her head when I asked.

  • History of illness: 8 clicks
  • Review of systems: 30 clicks
  • Changing current list of medications: 12 clicks per each medication added or removed
  • Prescribing new medication: 7 clicks per each medication
  • Physical exam: 4 clicks per each abnormal finding
  • Ordering labs: 4 clicks per each order
  • Entering diagnosis: 4 clicks per each medical problem
  • Treatment plan: 7 clicks
  • Follow up recommendations: 12 clicks
  • Documentation for billing: 10 clicks

This is for EACH patient. If she averages 25 patients per day, she’s clicking 2,500 times per day.

No wonder your doctor doesn’t have time to make eye contact.

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