Greg Hood, MD, Internal Medicine, 12:59PM May 12, 2013
Physicians commonly cite electronic health records (EHRs) as a top reason for dissatisfaction with the profession. With the stress of the expense in implementation, changes in work flow, and drops in productivity that are almost inevitable during implementation many voice yearnings for doing without the computer. In an article by Paul Miller at the Verge some may find a cautionary tale. After angst fueled him to decry the perceived negative consequences of "connectedness" he went a year without any internet access.
With words that would rhyme with thoughts familiar to many physicians he complained of burn out and wanting a break from "modern life-the hamster wheel of an email inbox, the constant flood of WWW information which drowned out my sanity. I wanted to escape." Continuing with what might sound like music to the ears of some physicians he states, "One year ago I left the internet. I thought it [the internet] was making me unproductive. I thought it lacked meaning. I thought it was "corrupting my soul." "
Physicians commonly, with some justification, claim that electronic records reduce productivity, at least initially. With or without EHRs concerns about professional fulfillment seem to be on the rise within the consciousness of the medical community. The "corruption" of the art of medicine and the patient-physician relationship are common refrains as well.
Physicians fantasize about a more simple and free approach to the practice of medicine. They dream of a life, whether after retirement or not, in which computers do not hinder quality of life, productivity, happiness or freedom. Therein may lie the great paradox. Computers and the internet, of course, are promoted as methods for improving precisely those same life aspects. So, which is it? Are we victims to ourselves more so than our technology? As the immortal Pogo said, "We have met the enemy and he is us".
This is not merely idle speculation. Physician retirements, many motivated to some degree by the EHR and data aggregation initiatives, are theorized to be a burgeoning epidemic in the next several years. Many physicians are resisting EHR implementation, even to the point of retiring. Paul said, "I thought the internet might be an unnatural state for us humans, or at least for me. Maybe I was too ADD to handle it". Many physicians echo his thoughts about the internet when expressing their fears about EHRs. The consequences of physician experiences in practice and with EHRs could have a tremendous effect on workforce planning issues in the very near term, particularly within primary care.
He said, "I didn't know myself apart from a sense of ubiquitous connection and endless information. I wondered what else there was to life. "Real life," perhaps, was waiting for me on the other side of the web browser...I'd find the real Paul, far away from all the noise, and become a better me." Instead, he found that his self-control remained at issue a year later, that productivity, accomplishments and epiphanies continued to elude him. As he concluded, "I didn't want to meet this Paul at the tail end of my yearlong journey."
While many physicians express great fear at the differences between accessing electronic charts instead of paper Paul found that paper maps and books were easy to get used to instead of electronic. His emotional interactions did change more profoundly, particularly interacting with those close to him in life, his sister, and friends, for example. As one rabbi he heard speak during his year said of the online lifestyle, "It's reprogramming our relationships, our emotions, and our sensitivity. It destroys our patience. It turns kids into "click vegetables."
So the conclusion from Paul's experience could be that it is not so much that the physical differences in the record keeping matters nearly as much as our own, human responses to it. As Nathan Jurgenson, an internet theorist pointed out to Paul, there's a lot of "reality" in the virtual, and a lot of "virtual" in our reality. When we use a phone or a computer we're still flesh-and-blood humans, occupying time and space. Furthermore, as physicians in an examination room, we must, in order to meet documentation guidelines, view every experience, encounter and action in terms of how we will enter this as data in the EHR.
Paul's plan was "to leave the internet and therefore find the "real" Paul and get in touch with the "real" world", but he "found out that the real Paul and the real world are already inextricably linked" to the internet and modern digital processes.
He said, "What I do know is that I can't blame the internet, or any circumstance, for my problems. I have many of the same priorities I had before I left the internet: family, friends, work, learning. And I have no guarantee I'll stick with them when I get back on the internet - I probably won't, to be honest. But at least I'll know that it's not the internet's fault. I'll know who's responsible, and who can fix it."
Perhaps this gained wisdom can help physicians as they struggle in front of their PC, Mac or tablet. Perhaps this perspective will help them look outside the room, and outside themselves, and better understand where they, the practice of medicine, and electronics all fit within "the real world".