FROM THE CHIEF MEDICAL EDITOR

I’m no fan of electronic medical records. It’s not that I think they are inherently evil — few love technology more than ophthalmologists. It’s just that the government forced them upon us in such a way that it caused otherwise avoidable problems. Deadlines have sent prices skyrocketing. The rules made systems horribly inefficient. Ever-changing regulations forced software companies to spend disproportionate resources complying with said regulations, instead of making their systems work better for us.

My sixth year in electronic dystopia is underway. And it’s not all bad — there is good, too. Like finding a patient’s chart immediately, instead of searching the entire practice’s square footage, and reviewing a chart located in a satellite office via keystroke instead of fax, hours after you need it.

But one negative feature that pops up in the medical^1,2 and lay press that I do not understand is how and why doctors literally turn their backs on patients to devote attention to their computer screens. Frankly, they should be worried about the figurative interpretation.

When I was on paper, a chart was in the chart rack outside the exam room door. I glanced at it to see the patient’s name. Then I walked in, said hello and some brief pleasantry, laid the chart on the desk and sat down to open and review the chart. I would say something like, “Give me a minute or two to refresh my memory on what’s going on.” As I sat at the desk, my patient waited in the examining chair, approximately 30 degrees to my right.

Now that I’m on the computer, not much has changed, save for reading a routing slip that lists the patients’ names. Once in the exam room I ask the patient to give me a minute to review his chart that’s waiting on the computer. My patient sits approximately 30 degrees to my right, same as always.

Not so elsewhere. I have seen some offices where the desk was so positioned that it forced the physician to sit with her back to the patient while she looked at the wall-mounted screen. Poor ergonomics — not the fault of anything else.

And for a related aside: For those of you who review the patient record before walking into the exam room, don’t think you get credit in the patient’s mind as time spent with him: It’s got to be up front and personal. OM

REFERENCES

1. Rousche L. How to stay engaged with patients—in spite of your EHR. Medical Economics, Nov. 10, 2016. https://tinyurl.com/krl4puw . Accessed May 18, 2017.
2. Gulko C. How to keep the Electronic Medical Record (EMR) from getting between you and your patient. Medpage Today. Aug. 23, 2016. http://tinyurl.com/m8xd2qo . Accessed May 21, 2017.