Lynn goes to the Doctor

The Doctor, by Sir Luke Fildes (1891)

Image via Wikipedia

Well, how is this for relevant?

Today, because my old and ongoing neck pain left me with a numb left hand yesterday that still hadn’t recovered by this morning, and also because I’m sneezing and wheezing every night all night despite the Allegra-D and Advair, I thought I’d better go see the doctor.

So I was pleased to get an appointment for this afternoon.

My doctor’s office has started using an EMR since I was last there and the medical assistant and then the doctor sat down in front of a keyboard in the exam room.

“How do you like having to do that?” I asked the doctor.

“I hate it. I like that I can find information when I need it but I hate that I spend all my time looking at this computer instead of at my patients.”

Funny she should mention that because…

As she sat in front of the keyboard (with her back to me after I’d jumped up on the table as asked), she asked if I’d ever tried this medication, if I’d ever tried that one. ย As she came across something she thought would help, she entered the prescription.

“This is going right to your pharmacy. No paper prescription. And here is an order for a neck x-ray.”

So as I was swept out of the office in record time, and was handed a printed up summary of my visit on the way down the hall (I barely slowed down) I realized something.

I’ve had asthma since I was 8 years old. In all the years that I’ve gone to the doctor with all my seasonal allergy woes, I have never once NOT had my breathing listened to, or my nose, eyes, ears, and throat checked. ย I’ve never NOT been asked how many times I was having to use my rescue inhaler.

Wow.

Isn’t it amazing how that EMR made it possible for that doctor to treat me, send my prescriptions straight to my pharmacy, order my neck x-ray, and hand me a printed summary of my visit all without ever examining me?

Maybe next time I can just answer a few questions on a website. Who needs a doctor at all?

So why then am I sitting here still wondering if I am doing permanent damage to my nerves by not treating my neck problems, if I can continue doing yoga without causing harm, and if my asthma is going let me get through the fall without a trip to the ER?

Technology is a wonderful thing….

-Lynn

5 Responses

  1. I think a more pertinent question to ask is why are you sitting there asking us those questions? Why didn’t you ask your doctor? It appears that your mouth was working at the time because you asked her how she liked the magic machine.

    Lynn, you’re acting just like my 82-year-old mother does when she goes to the doctor. She answers only the questions asked. She doesn’t offer much in the way of additional information (like having a history of something). She notices how they dictate or use a computer because she thinks her daughter the MT would be interested. When she gets home, she complains about all the answers she didn’t get to the questions she didn’t ask and proceeds to ask me or my sister, a former paramedic. OK, I understand that she came from a generation who thought docs were next to God and you did what they told you to do and didn’t bother them with excessive questions. My guess is that you’re from my generation, Lynn,or maybe younger, and we don’t have that excuse.

    If you didn’t ask your doc those questions and if you didn’t remind her of the asthma history (in case it didn’t make it into the magic machine or is just one little tree lost in its forest of information) and express your unease at not being examined, then don’t blame your unhappiness soley on the magic machine. Speak up next time.

    Now, if you did ask those questions and expressed unhappiness at not being examined – and maybe even did it more than once – and still got blown off, then maybe what you need is a different doc. It’s still not the magic machine’s fault.

    I hope the x-ray doesn’t find anything bad and that the prescription helps your allergies/asthma. You are going to make use of what you did get out of the encounter, right?

    • I know!! I can’t believe I didn’t say something! I think you all know me well enough to know its not like me to be “quiet” and take my medicine like a good girl! I let them herd me out of there like a sheep!

      This doctor isn’t normally like that… maybe I was in shock. ๐Ÿ™‚

      You are absolutely 100% correct Karen – it IS up to patients to speak up. And I SHOULDN’T blame it on the machine…. and believe me, it will not happen this way again.

      But what about the 82-year-olds? Or the patients too old to go to the doctor with their mothers, but too young to know better.

      And what about when the old-school doctors retire and the new ones enter the field who have never talked to a patient without a computer between them?

      Will physician intuition and examination go by the wayside to be replaced by asking the questions in that EMR template?

      I guess we’ll have to wait and see…

      But until then…bahhhhh. ๐Ÿ™‚ (Lynn’s sheep imitation) ๐Ÿ™‚

  2. Lynn, my cardiologists have had an EMR for about 10 years now. I really don’t find their use of it to be any more distracting than my internist making handwritten notes. The advantage for me is that if I get sick anywhere in an area of northern Illinois that is about the size of the entire state of Rhode Island and am capable of telling the ER doc that I belong to this group, then their doc covering that hospital can get my office record immediately which can’t be said for my internist’s paper records if it’s after hours or even my hospital records (the HIPAA hippo likes to play with hoops – make it hard enough and the patient/doctor will go away and leave her alone). Plus, with the E-prescriptions, I don’t have to worry about misplacing them if I don’t need to fill them right away.

    A typical visit for me starts with signing in and reviewing the printout of the contact info, insurance info, primary care MD name and medication list from the machine. When it’s my turn, the nurse takes the vitals signs and enters them, goes over any changes I’ve made on the printout and asks what brings me in. Depending on the answer, she may have a few more questions. She enters the changes and answers in the machine. I give her any copies of lab work I have from my primary care MD. She’ll scan them in later. Doc comes in, says “hi” and takes a quick look at what’s been entered. We talk about why I’m there. He does the necessary exam. We tells me his recommendations. He enters any E-prescriptions I need. If he has a few minutes, we talk shop (I used to transcribe for him in a past life).

    The thing is, having the EMR was something the practice wanted because they saw the benefits to their patients and to themselves. It is something that they have configured to their needs. It wasn’t something picked out for them and shoved down their throats by someone else with cheap and easy to set up and maintain being the only criteria for purchase. They still use MTs, largely to document the thought process behind their choice of treatments for patients and, of course, referral letters, insurance letters and the like. It’s just not a bad experience.

    I think younger docs will handle EMRs better than some of their older colleagues because it will be how they were trained and all they know. They won’t be forced into changing their methods kicking and screaming. And hey, “Bones” McCoy never lost his bedside manner even with a tricorder that made the diagnosis for him! (she smiles)

    • Hi Karen: I absolutely agree that the EMR is a good thing – when its used as you have experienced with your cardiologist to enhance the physician – patient experience. An important comment that you make is “they still use MTs, largely to document the thought process behind their choice of treatments…”

      This is the part that is often missing in an EMR implementation since to many CFOs “EMR” equals “we don’t need transcription anymore” which in many cases means they are no longer capturing those all important thought processes.

      Obviously your cardiologist’s practice saw the value in preserving a space for narrative dictation – and thus is not revamping the way he/she treats patients according to the EMR template. I think many practices, especially those part of larger health systems, are being forced to accept technology that doesn’t fit their needs as well as your cardiologist’s does.

      Hopefully we’ll see more experiences like yours going into the future and fewer like mine!

      Thanks for your comment!
      Lynn

  3. […] O’Connor’s article, along with descriptions of patient experiences, including my own and the one described by Robin Daigh on MD-IT’s blog seems to support the need to consider […]

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