Screened Out by Pat Conrad MD

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It is pretty apparent by now that humans are in the early phases of evolving into cybernetic organisms. I can’t say how many generations we will need to turn over before certain automation/efficiency/preference genes start predictably expressing themselves, but we seem to be well on our way.

Sumathi Reddy tells us in the Wall Street Journal about a recent JAMA study that finds doctors spend about a third of patient contact time staring at computer screens. My first thought is that figure is a low ball. The study also informs us that patients don’t like the lack of eye contact. And my next thought is $#@*& you, #@!)*&^!

  • “Experts say lack of eye contact is the biggest problem with having to input information into a computer. Eye contact establishes trust and a bond with patients and a lack of it can be alienating. It also prevents physicians from being able to read body language and cues from patients.” But that only matters if one is treating people, and that is not the job of the brave new physician-as-team-member. We are not treating individual humans, but trends, conditions, and populations, with codes, best practices, core measures, and pre-authorized exceptions. Why worry about establishing trust with a client who cares more about what their insurance company thinks, and who will have a better bond with their sister-in-law’s malpractice attorney boyfriend?
  • “Mary Mitchell, a 68-year-old in Raleigh, N.C., said when she went to see a new primary-care physician recently she made eye contact with him just once. “He raced through the medical record, assigned a half-dozen tests and told me to come back,” said Ms. Mitchell. “He shook my hand when he left and that was the only real eye contact we had.” Let me explain Ms. M: by taking Medicare, your primary provider team member has already racked up considerable overhead and debt, which must be satisfied by rapidly moving room to room to try and make up it up on volume. At 68, your health care is guaranteed by a pandering political system, whose promises will be passed on to your primary, who will not get paid unless he churns out your brief exchange on an expensive computer system that the government, acting as your agent, forced him to buy and use. And let’s face it Ms. Mitchell, thanks to inflation, in a couple years you will have consumed all that you ever contributed to Medicare, and your remaining years will be on someone else’s dime, so try to enjoy the ride and let’s keep the complaints down, huh?

We really are starting to see genes express that make us subconsciously prefer, and even defend big cyber-web medicine. How else to explain this gem: “While electronic records have been used by some health-care networks for more than a decade, their use has rapidly increased in recent years due to federal incentive funding.” Incentive??! The “incentive” is to avoid a mandatory rate penalty for anyone not buying these infernal systems. It is beyond deceitful to use the word “incentive” in a way suggesting physicians to have made un-coerced business decisions.

The article describes Dr. Margaret Wheeler’s “love-hate” relationship with EMR’s, and that “she often apologizes since it forces her to turn away from the patient.” And now her hospital is offering medical scribes – “often volunteer medical students” – to bridge this comfort gap. So these labor saving devices have now caused the need for another layer between patient and doctor. Will the poor drafted med student kindly step behind the curtain while we perform this rectal? If the scribe is paid a wage, who picks up the cost? Surely not the patient. If the scribe is a med student, am I protected from any transcription errors by sovereign immunity?

  • A JAMA Internal Medicine study videotaped 71 physician-patient encounters in San Francisco in a population “with limited English proficiency and health literacy” (At this point I really regret writing this piece without any hard liquor nearby). Most exams were performed in the patients’ native language.” Researchers found mixed blessings, wherein more screen time correlated to more “social chitchat” time with patients; more screen time also led to correcting the patient more on medications, which “might” inhibit “patients’ engagement with their care.” And those patients also gave their docs lower quality marks.
  • One doctor leads courses in “health communication skills”, whose recommendations include teaching the patient how and why the computer is used.
  • Some docs are described leaving the computer outside and charting after the visit. That’s fine, since we all have plenty of extra free time during the day. Of course NOT documenting half the required, largely useless info would save gobs of time but not money, because then you wouldn’t get paid…
  • One pediatrician loves the screens for showing parents the kids’ growth charts, adding “The kids really like it,” she said. Non-English speaking patients grading docs on quality of care based on computer time, and pediatricians justifying these systems because the new little pod beings are starting to express a preference.

I dread the day that the health cyber net discovers that I don’t think the computers are necessary for good care and decides to cut m… <transmission ended>

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  1 comment for “Screened Out by Pat Conrad MD

  1. Sir Allyagottadois
    January 26, 2016 at 8:19 am

    As a solo physician with like opinion, I have put a 32 inch screen on the wall so the patient and I sit and look at the record. They like it. I like it and it serves a purpose dealing with the lack of eye contact.

  2. Steve O'
    January 25, 2016 at 9:14 am

    -Every so often, a damn-fool idea sweeps through the population like rotavirus in a day-care center, and results in a similar product, only coming from grownups rather than toddlers.

    -The Victorians, rationally, thought that ENTIRELY too much attention and effort was being spent on sex – attention that could be better spent on more noble things as Crown and Empire, keeping down the brown, and other necessary enterprises. An entire culture was focused upon Not Thinking About Sex. To point out its efficacy, the world population was about 1.6 Billion then, and is 7.5 Bn now, so that shows the efficiency of clever and grandiose new ideas.

    -Our latest humanophobic jag is not focused on procreation, but rather mentation. We are no longer shamed by our piddle organs, but by the one that separates us from the beasts, relatively-speaking. If meat can do it, metal can do it better.

    -As in the Victorian Era (and STOP THINKING ABOUT SEX FOR A SECOND!) we risk looking like a pack of damnfools. The whims of the elite don’t stop human nature, no matter how many times we choose to “unfriend” it. Human thought does not become inferior to silicon algorithms, no matter how often we wish it were so. We again risk puffery, hypocrisy and damnfoolery on an epic scale, just along a different venue. We go in cycles of such absurdity, and probably have done so since human discovered fire.

    -We also have raced ahead in our ability to dabble in genetics, with the potential of even more mischief. However, evolution favors those processes which make survival more likely; I think that skill is beyond our pay grade as well.

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