There’s an old saying that “the inmates are running the asylum.” In our current healthcare system, it’s the computers who are running the hospital.
It’s been four years since I admitted a patient to the hospital; my practice reduced now to outpatient surgery only. But recently my wife was hospitalized and I had a rare opportunity to observe hospital care from the family member’s perspective. I spent hours sitting with my wife and observing how differently hospitals function since I first entered medical school.
It’s been over forty years since I began my medical career. Back then the doctor was king and the nurses majored in patient care and the needs of the doctor. When a doctor made rounds on the patients in the hospital, the nurse went along to update the doctor on the patient’s condition and take orders on any changes needed to the patient’s treatment. Computers were people who did mathematics.
Doctors spent most of their time seeing patients, doing procedures, and staying up-to-date on medical knowledge. Nurses spent most of their time in patient care and a minimum of time doing paperwork.
Today is very different. Each time the nurse came to see my wife she, or he, was pushing a rolling computer stand. They spent more time looking at the computer screen than they did looking at my wife. They were certainly pleasant, generally efficient, and mostly competent – but they were obsessed with the computer.
They had to scan an identification band on her wrist before they could do anything. They needed “computer approval” before they could give any medication, record any vital signs, or make any requests. If I went to the nursing station to find help, I was sure to find everyone there engrossed in their own separate computer.
Each time the doctor came to make rounds, the nurses were nowhere to be found. The rapport between doctor and nurse that I had always found critical to good patient care was nowhere in evidence. All communication seemed to be via the ubiquitous computers. This was most evident when my wife was discharged and her release was delayed nearly an hour because of computer malfunction. I’m not sure if she would have ever been permitted to leave the hospital if not for the fact that the nurse didn’t want a confrontation with a family member who is on the medical staff.
I’m sure these nurses are doing their best to provide good patient care but they are hamstrung by their subservience to the computer. Doctors are not immune from the same problem.
According to a new study published in Health Affairs, doctors now spend an average of 3.08 hours on patient visits and 3.17 hours on their computers each day. The authors said, “Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in the time allocated to desk-top medicine (computers).”
Furthermore, since doctors are paid only when they see patients and not when they spend time on the computers, they are receiving less compensation. The authors suggested their findings highlight the misalignment of the current fee-for-service payment policy and the potential for physician burnout with EHR (electronic health records) use.
A separate study appeared in the Annals of Internal Medicine in 2016 noted doctors spent only 27% of their office day on direct face time with patients but nearly half (49.2%) of their day on computers and other desk work. Even when in the exam room with patients, only about half (52.9%) of that time was spent talking to the patients while 37% was spent on the computer or other desk work. Then, at the end of their day, doctors spent about 2 more hours completing EHR or other desk work.
Decreased time in patient care, decreased control of the healthcare treatment environment and decreased compensation all lead to frustration in providers, both doctors and nurses, and a diminished patient care experience. This is contributing to the doctor shortage as more and more doctors retire early and fewer doctors are trained. This trend will not have a happy future.