Students’ Lounge
A monthly feature written by the students of U of L Medical School
22
righting the ship
Ben Rogers
I
was rotating through a local hospital
the afternoon its Electronic Medical
Record (EMR) went live. My resident
was technologically savvy, so as we saw
patients I asked questions and she entered
the information into the new electronic
chart. However, whereas my evaluation
had formerly been sufficient, the system
often wanted superfluous information. This
left my resident asking a series of questions that left even our
patient confused as to why they were pertinent. At one point,
my resident seeing this emotion in a patient’s face said, “Sorry,
I just do what the computer tells me to.”
Physicians are facing a virtual landslide of technological
innovations. Within this year alone I’ve seen advertisements
for a machine that is meant to scan for melanomas, one that
is supposed to be a safe alternative to anesthesia in low risk
surgical procedures, and several more for various forms of
robotic physicians. So, when I sit in a preceptor’s office and he
tells me that his single greatest piece of advice is to never sit
and stare at a computer screen while I’m seeing a patient, it is
impossible to not feel a disconnect.
Taking EMR as an example, it’s clear that it will provide
improvements in our patient’s medical lives. Formerly, a
community practitioner might see a patient and his or her
entire family throughout a lifetime, keeping notes on family
history, allergies, prior surgeries, and so on. However, our
patient populations are more mobile now and interventions
more numerous and diverse, so naturally it is becoming
more difficult to manage all their personal data. EMR offers
interesting solutions. Not only would a unified medical record
keep information from slipping through the cracks, it allows
incredible opportunity for the analysis of large amounts of
data. Much of medicine is pattern recognition, and physiciandirected interpretations of trends found through EMR are going
to play a big role in the future of disease control, prevention, and
discovery. Remote links help rural patients and doctors connect
to urban specialists. The portability of medical records is greatly
enhanced for patients. There are good things happening.
However, the data from a survey of over 10,000 patients
performed by JD Power and Associates was released in September
of last year and the results showed far and away that interpersonal
skills of staff were a much more important factor in determining
satisfaction than facilities or equipment. Satisfaction may be
an important marker of future adherence and medical literacy,
LOUISVILLE MEDICINE
ignoring the more obvious way it is related to general comfort
with a practitioner. Further, retrospective analyses of former
technological innovations have shown that often-unexpected
negative consequences may result from our best-intended
practices. We have all seen side effects from antibiotics and the
numbers on the cost of unnecessary CT scans in our country,
so I believe that it goes without saying that any technologies we
produce will only generate the same sort of issues.
Additionally, studies have shown that adoption of advanced
medical technologies accounts for the largest percentage of
growth in health care spending in the United States when
compared with other developed countries.1 Ignoring patient
satisfaction and negative outcomes, this one fact alone should be
enough for us to take pause and consider where our profession’s
technological future lies.
Of course, technology doesn’t just refer to medical records or
machines. Lab tests and online resources and thousands of other
developments compete for our attention from every direction.
It will be essential that physicians develop ways to navigate the
new terrain. In coming years there will likely be a nationally
standardized resource that physicians will be able to reference as
new faculties become available. In the meantime it is imperative
that as a profession we demand objective data regarding each
new product, test, or treatment we intend to employ. Further, we
must be ever conscious of how changes we plan to implement
will affect cost burden to the system. It seems likely the future
will also be one in which our patients have access to benefit, cost,
and outcomes data regarding our treatments and it behooves us
to help lead the way to transparency.
Technological changes will afford us tremendous opportunities
to advance the art of medicine. However, only if we analyze
each implementation rigorously will we be able to ensure that
the unintended negative effects don’t intrude on the physicianpatient relationship. In short, we must be the captains of this
ship or else all our advancements will be for naught. LM
References:
1 http://www.ncbi.nlm.nih.gov/pubmed/23404417
Note: Ben Rogers is a fourth-year medical student at the University
of Louisville. He is currently interviewing for internal medicine
residency programs.