Doctors and the New Bedside Manner

 

Having trouble making eye contact with your doctor lately? You’re not alone.

It’s difficult to look your patient in the eye while you’re staring at a computer screen. That’s the dilemma that many doctors face every day in this new era of electronic health records (EHRs).

Ever since the Obama administration mandated that doctors and hospitals implement EHRs by 2015 or suffer penalties in Medicare reimbursements, there has been a change in the way many doctors practice medicine. The Center for Medicare and Medicaid Services (CMS) has been deducting 1% from the Medicare fees paid to doctors and hospitals who are noncompliant with EHR implementation standards. These fees will rise higher in the coming years.

Sumathi Reddy, writing in The Wall Street Journal, says this has changed the dynamics between some doctors and patients and created new communication challenges, research shows. She cites a recent study published in the Journal of the American Medical Association (JAMA) in November found that patients rated the care they received lower when doctors looked at a computer screen a lot during patient examinations. Also, researchers at Northwestern University discovered that doctors using EHRs spent about a third of patient visits looking at a screen. The study, which analyzed eye-gaze patterns in videotapes of about 100 patient visits, was published last year in the International Journal of Medical Informatics.

Earlier this year, I posted a report (Electronic Health Records – Another ObamaCare Train Wreck) that highlighted several myths about EHRs promoted by the Obama administration including:

  • Reducing medical errors
  • Increasing the efficiency of medical practices
  • Lowering the costs of healthcare
  • Improving the quality of healthcare by delivering “evidence-based medicine”

 

That report also noted two important surveys and a study. The first is a 2014 survey by the industry group Medical Economics that discovered:

  • 67% of doctors are “dissatisfied with EHR functionality.
  • 73% of the largest practices would not purchase their current EHR system
  • 45% of respondents say patient care is worse
  • 65% of respondents say their EHR system results in financial losses

 

The second survey by Deloitte found that three of four physicians think EHRs “increase costs.” Three reasons are given for these increased costs:

  • Physicians can no longer see as many patients per day
    • Higher prices are charged to compensate for lost revenue
  • High implementation and maintenance costs
    • Agency for Healthcare Research and Quality reported the average five-physician primary care practice would spend $162,000 for implementation – and another $85,000 in first-year maintenance.
  • Small practices cannot compete – and sell out to hospitals
    • Hospital charges for the same services are higher

 

The study in Perspectives in Health Information Management found that EHRs encourage errors that can “endanger patient safety or decrease the quality of care.” America witnessed a real-life example of this during the recent EBOLA crisis, when “patient zero” in Dallas, Thomas Eric Duncan, received a delayed diagnosis due in part to problems with EHRs.

Now, in addition to all these problems, we can add diminished patient-doctor communication.

To combat this new problem, Richard Frankel of the Regenstrief Institute and Indiana University School of Medicine has proposed an acronym POISED to help doctors improve communication if they use EHRs.

P – Prepare: Review the electronic medical record before seeing the patient.

O – Orient: Briefly explain how the computer will be used during the appointment.

I – Information Gathering: Enter data to show patients’ concerns are being taken   seriously.

S – Share: Show the computer screen so the patient can see the information.

E – Educate: Display a graphic representation of, say, the patient’s weight or blood pressure over time.

D – Debrief: Make sure the patient understands what you said.

 

My advice? If you see the doctor walk into the exam room holding a laptop computer, politely excuse yourself and find another doctor. No doctor should allow the government to compromise the treatment of their patients. I have refused to comply with this mandate and other doctors should do likewise.

 

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