and time of arrival.”
“ We are 25 minutes out and the patient is in ventricular tachycardia at a rate of 180 / minute. His blood pressure is 90 / 40 and his oxygen saturation is 95 percent. We don’ t need to shock him. We have started IV Amiodarone.”
“ Is he responsive?”“ Not really, other than to say,‘ I feel horrible,’ over and over.”
“ Does he have any ID? A name tag on his racing vest? Anything to tell us his name or the city where he lives?”
“ Yes, his name is Ben Smith and he lives in Indianapolis, Ind.”
“ OK, we will use the EHR system and see if we can locate any information on him.”
“ Dr. Jones, we have located Ben Smith’ s records at University Hospital in Indianapolis. He is a surgery resident and has a history of concealed WPW syndrome.”
“ Ambulance One, how far out are you now?”
“ Still 20 minutes because the runner was at mile 21 when he dropped to his knees and almost passed out.”
“ Ambulance One, stop the Amiodarone immediately and bolus the patient with IV Pronestyl and start a drip. We will be ready when you arrive.”
“ Trauma Room 1- we just pulled in.”“ Take Mr. Smith to Trauma Room 1.”“ Mr. Smith, you are sitting up and look fine.”“ I know, I think I converted coming into the hospital.”
“ Hook him up to an EKG.”“ He is back in sinus rhythm with a narrow QRS complex. He has a history of concealed WPW syndrome.”
“ Dr. Smith, we know you are a surgery resident in Indianapolis. When did you find out about your arrhythmia?”
“ I was in high school running track, and every now and then my heart would race for a few minutes. I told my dad, a primary care doctor, and he sent me to a cardiologist who made me wear a 30-day event recorder. I will never forget; I was on the 29th day thinking this recorder was such a waste of time when the arrhythmia started. At first they thought my diagnosis was ventricular tachycardia, but with the regular wide QRS complex and a normal EKG, they diagnosed me as concealed WPW syndrome. I only have these episodes once every three to five years and the episode usually lasts less than two minutes. I don’ t remember anything earlier today, but I felt like I was going to pass out.”
“ Well, you are back in regular rhythm and we assumed you want to go back to Indianapolis to get your WPW ablated. We will send your EHR to University Hospital in Indianapolis. Do you need transportation now? Who can we call to pick you up?”
“ My parents are out of the country and I drove myself to the race because I am staying with my 93-year-old grandma.”
FEATURE
“ We will help you find a way back to your grandma’ s house.”
“ Grandma, do not worry about anything. I am fine. I will back to your condo in a few minutes.”
“ Ben, I was so worried about you when the hospital called. But they told me you were fine- thanks to those fancy record things or whatever you call them.”
“ Grandma, I learned a valuable lesson today. You dislike Electronic Health Records because your doctor does not sit beside you. I dislike them because I spend too much time in front of a computer rather than in the operating room or with a patient. However, my own Electronic Health Records were vital to my treatment today. I was so weak I did not know what was going on and I could not even tell them about my arrhythmia. I was feeling worse in the ambulance, the hospital received my records from Indianapolis, changed my treatment and I stabilized quickly. Because of quick access to my EHR, I did not get shocked and my treatment was altered specific to my condition.”
“ I am so glad for you honey; but I have one question before you head back home. How many patients like you are“ saved” by Electronic Health Records versus how many patients like me lose a more intimate doctor-patient relationship because of Electronic Health Records? Saving your life today is much more important to me than how a doctor interacts with your Grandma in the exam room; however, most patients over the age of 50 will remember when they could talk to their doctor in confidence and with more intimacy than now.”
“ Yes, Grandma; I remember I told you when I graduated from medical school a good 25-30 percent of the class became doctors with tremendous“ head knowledge” to take care of their patients; but those same individuals are not be able to relate to their patients personally because they are more interested in the science of medicine than the art of medicine. I promise you I will remember today for the rest of my life practicing medicine. I will never forget modernized EHR and other new modalities are responsible for bringing medicine into the 21st century; however, I will remember the patient is still a human being with emotions, needs and concerns that no computer or no test can allay. Only a human touch or a time of intimate conversation can help many patients feel better about him or herself.”
David Dageforde, MD, is a retired interventional cardiologist with Norton CardioVascular Associates and now serves as Board Chair for the Shawnee Christian Healthcare Center.
NOVEMBER 2017 13