Free Daily Headlines :

  • COVID-19
  • Vaccine Info
  • Money
  • Politics
  • Education
  • Health
  • Justice
  • More
    • Environment
    • Economic Development
    • Gaming
    • Investigations
    • Social Services
    • TRANSPORTATION
  • Opinion
    • CT Viewpoints
    • CT Artpoints
DONATE
Reflecting Connecticut’s Reality.
    COVID-19
    Vaccine Info
    Money
    Politics
    Education
    Health
    Justice
    More
    Environment
    Economic Development
    Gaming
    Investigations
    Social Services
    TRANSPORTATION
    Opinion
    CT Viewpoints
    CT Artpoints

LET�S GET SOCIAL

Show your love for great stories and out standing journalism

Op-Ed: Doctors and computers — not the best examining room combo

  • Other
  • by Christine Woodside and Dr. Kristen Zarfos
  • December 5, 2014
  • View as "Clean Read" "Exit Clean Read"

Researchers conducting dozens of studies in recent years have asked patients how they feel when their doctors stare at personal digital assistants or laptop computers instead of at them. Several of their studies in peer-reviewed journals concluded that technology in a doctor’s lap is good. We challenge this premise.

We think America is bumbling through the Dark Ages of examining-room technology.

Op-ed submit bugElectronic medical records might seem inevitable, but using them properly still flummoxes practitioners. Only a quarter of 20,088 doctors surveyed this year for the Physicians Foundation said that this technology streamlines their workloads, and almost half of them complained that it hinders a decent bedside manner.

We are a patient and her doctor. We believe that doctors looking at screens can’t examine people. Doctors conducting a physical exam and asking questions now must very quickly turn to the keyboard. We don’t think they can do that in the examining room with any consistent success.

We have read through many of the peer-reviewed studies of this technology. We find evidence of a defeatist attitude about computers next to examining tables. If we had to invent a slogan for the current approach it would be: computers first, reasons for them second.

Let’s go back a few years. A study in the Journal of American Medical Information (in 2009) listed a “paucity of evidence” that these devices helped doctors treat patients. A 2010 report in Family Medicine claimed that although most patients perceive tablet computers positively, their attitudes differed: by age in how fast doctors could look up files, by race in worries the office was less personal, and by race and education level a feeling that the tablets took away privacy.

Newer studies suggest greater acceptance. In the Journal of Health Communication, a 2012 article said that patients who watched a brief presentation about why their doctors used PDAs or smartphones “increased measurable perceptions” of the devices.

We think that whether doctors explain to patients why they are holding PDAs or computers in their laps misses the actual problem — distraction.

Last winter, in the journal Academic Medicine, William Bynum, M.D., wrote that doctors “need to be more than automated medical kiosks.” But he didn’t say technology is a problem. He said doctors are the problem. Dr. Bynum claimed that medical leaders can “embrace and promote technological advancement while at the same time working to maintain the human connection that physicians have with their patients.”

We detect, again, an attitude of submission to technology companies. We say no. We think that—like the people who can’t concentrate on more than one task at a time—doctors expected to be caring practitioners and medical recorders will fail at one or the other of those tasks.

Doctors, nurses, physicians’ assistants, and other health workers have dealt with distractions forever, and when pressed, they will neglect record-keeping for the patients. A study by Scott R. Walter published in March in the journal BMJ Quality and Safety summarized the actions of 200 clinicians over 1,000 hours in Sydney, Australia. The authors wrote, “Documentation was generally given low priority in all groups, while the arrival of direct care tasks tended to be treated with high priority.” That doesn’t surprise us, but we point it out because we believe that computers have introduced even more distraction than previous record-keeping methods.

A 2013 study by computer experts Pushpa Kumarapeli and Simon De Lusignan in the Journal of the American Medical Information filmed 163 doctor-patient consultations using various computer-record systems. They found that 61 percent of the time, the doctor was directly interacting with the patient—15 percent actually examining the body, 25 percent using the computer, and 14 percent allowing the patient to look at the computer too. (They did not explain the remaining 7 percent of the examining time.) The conclusion of this study? That the record-keeping systems “should be designed to facilitate multi-tasking.”

The patient of us goes to a doctor whose office provides an online database of her health record. This record includes errors, even those pointed out previously. But the staff spends a fair amount of time entering data into this record, which takes away from their work with patients.

Dr. Suneel Dhand complained about the feeling of straddling two very different tasks in an essay last year for medpagetoday.com. “Now, instead of demands to see more patients in less time or increased bureaucracy from insurance companies, it is the time we are spending with computers that is increasingly taking us away from our patients.”

We agree. We have experienced these distractions from both sides of the exam table. Doctors stroking keys struggle against time that always gets away from them. Patients fear that their doctors care more about entering information into their devices than what the patients say.

Looking at a screen means one ignores the person sitting there. This seems as bad to us as the most stereotypical smug and distracted practitioner who interrupts a stuttering patient.

We both believe that time is a doctor’s most valuable commodity. Time with patients builds relationships. A doctor must earn trust by making eye contact and truly listening. A doctor learns a great deal just by watching patients’ responses to questions and listening to how they describe their problems. One can’t put a value on this.

If technology functions as efficiently as the manufacturers say, health offices and hospitals need scribes in every examining room. The skill of recording data and locating records is specialized. The doctor of us asked for a scribe at her previous job and was firmly rebuffed.

Scribes will undoubtedly increase the amount of information in a patient’s records. That will create new problems. Sometimes the overwhelming bulk of information can obscure the salient facts in a patient’s case.

As Abigail Zuger, M.D., wrote in an October 13 article in The New York Times, “Like computer servers everywhere, hospital servers store great masses of trivia mixed with valuable information and gross misinformation, all cut and pasted and endlessly reiterated. Even the best software is no match for the accumulation. When we need facts, we swoop over the surface like sea gulls over landfill, peck out what we can, and flap on.”

The doctor of us sits on a committee that will list important questions for breast care in an electronic medical record system — essentially, instructing the computer. Obviously a lot of care will go into this program. That does not change the basic problem we’re talking about. Physicians using electronic medical records say that the burden of inputting data clearly subtracts attention and time they could devote to patients.

Dozens more studies of the effects of technology on patients are out there or in progress. We say: ask the proper questions in these studies. Ask not how we can get patients to accept technology as if it were inevitable, like an asteroid plummeting to Earth. Ask whether we’re on the right track with this invasion of technology into the space of deepest human connection: the place where a doctor looks at a patient’s body and figures out whether he or she is sick.

Health and life are precious. They are also complex. They cannot fit into a size-4 time slot when a size-12 time slot is required.

Christine Woodside is a journalist in Connecticut.  Kristen A. Zarfos, M.D., FACS, is a surgeon specializing in breast and thyroid surgery at the Hospital of Central Connecticut. We thank Maryrose Keenan, MLS, for her help with research.

Sign up for CT Mirror's free daily news summary.

Free to Read. Not Free to Produce.

The Connecticut Mirror is a nonprofit newsroom. 90% of our revenue comes from people like you. If you value our reporting please consider making a donation. You'll enjoy reading CT Mirror even more knowing you helped make it happen.

YES, I'LL DONATE TODAY

ABOUT THE AUTHOR

Christine Woodside and Dr. Kristen Zarfos

SEE WHAT READERS SAID

RELATED STORIES
Best of 2019: Key Dems press bill to increase minority recruitment at Coast Guard Academy
by Ana Radelat

The bill is a response to allegations of discrimination and a racially hostile environment at the school.

Navy cuts number of EB Virginia-class subs in new contract
by Ana Radelat

Electric Boat wanted the Navy to include 10 subs, and possibly 11, in the so-called "Block 5" contract. But the Navy agreed to only nine.

Electric Boat facing mounting challenges as sub work ramps up
by Ana Radelat

There continue to be concerns about EB’s ability to build the new Columbia-class submarine alongside its smaller Virginia-class attack subs.

Talk of gun violence, little else
by Paul Stern

In national politics last week there was talk of little else than gun violence, white nationalism and gun control following the fatal shootings of 31 people in Dayton, Ohio and El Paso, Texas. There was little more than talk, too.

Politics and the ‘dark psychic force of collectivized hatred’
by Paul Stern

President Donald Trump insists he is not a racist, but 51 percent of Americans believe he is, according to a Quinnipiac University poll released last week. Certainly his “send her back” comments about Somalia-born U.S. Rep. Ilhan Omar of Minnesota and last week’s jabs at U.S. Rep. Elijah Cummings of Baltimore did nothing to dispel that […]

Support Our Work

Show your love for great stories and outstanding journalism.

$
Select One
  • Monthly
  • Yearly
  • Once
Artpoint painter
CT ViewpointsCT Artpoints
Opinion Assisted suicide lobby spreads falsehoods to promote systemic ableism
by Stephen Mendelsohn

Proponents of assisted suicide repeatedly spread falsehoods to promote their lethal and ableist agenda.  The February 8 op-ed, “Aid in dying is not assisted suicide” is no exception. Suicide is defined as the act of taking one’s life intentionally.  The person who intentionally ingests a prescribed lethal overdose more closely fits the dictionary definition of suicide than the despondent person who jumps off a bridge.  The desire for suicide is a cry for help, even when redefined as a “medical treatment option.”

Opinion TCI will create a fourth gasoline tax
by Christian A. Herb

The Transportation Climate Initiative, or TCI, calls for a proposed emissions fee on gasoline to help battle climate change. On the surface, supporters say it is a small price to pay to help save the planet; and if you truly believe that this is the case, then you should consider voting for it. Despite the administration’s efforts to go out of their way to not call TCI a tax, the simple truth is that it will only create additional financial hardships on lower- and middle-income families struggling to make ends meet during the pandemic.

Opinion Let’s keep telehealth when the pandemic ends
by Steven Madonick, MD

Telehealth may lead to positive, even transformational changes in psychiatric care, and Connecticut needs to keep it after the pandemic. Connecticut needs to pass the necessary laws to continue telehealth and telephonic care.

Opinion The public health bill no one is talking about, but should be
by Brian Festa

On February 16,  the legislature's Public Health Committee conducted a public hearing on two bills, S.B. 568 and H.B. 6423, both of which would eliminate the religious exemption to mandatory vaccinations for Connecticut schoolchildren.  The hearing was capped at 24 hours, depriving nearly 1,500 members of the public who had registered for the hearing their opportunity to be heard.  The vast majority of those who did testify, and who submitted written testimony, opposed the bill.  The committee is expected to vote on the bill as early as  today. 

Artwork Grand guidance
by Anne:Gogh

In a world of systemic oppression aimed towards those of darker skintones – representation matters. We are more than our equity elusive environments, more than numbers in a prison and much more than victims of societal dispositions. This piece depicts a melanated young man draped in a cape ascending high above multiple forms of oppression. […]

Artwork Shea
by Anthony Valentine

Shea is a story about race and social inequalities that plague America. It is a narrative that prompts the question, “Do you know what it’s like to wake up in new skin?”

Artwork The Declaration of Human Rights
by Andres Chaparro

Through my artwork I strive to create an example of ideas that reflect my desire to raise social consciousness, and cultural awareness. Jazz music is the catalyst to all my work, and plays a major influence in each piece of work.”

Artwork ‘A thing of beauty. Destroy it forever’
by Richard DiCarlo | Derby

During times like these it’s often fun to revisit something familiar and approach things with a different slant. I have been taking some Pop culture and Art masterpieces and applying the vintage 1960’s and 70’s classic figures (Fisher Price, little people) to the make an amusing pieces. Here is my homage to Fisher -Price, Yellow […]

Twitter Feed
A Twitter List by CTMirror

Engage

  • Reflections Tickets & Sponsorships
  • Events
  • Donate
  • Newsletter Sign-Up
  • Submit to Viewpoints
  • Submit to ArtPoints
  • Economic Indicator Dashboard
  • Speaking Engagements
  • Commenting Guidelines
  • Legal Notices
  • Contact Us

About

  • About CT Mirror
  • Announcements
  • Board
  • Staff
  • Sponsors and Funders
  • Donors
  • Friends of CT Mirror
  • History
  • Financial
  • Policies
  • Strategic Plan

Opportunity

  • Advertising and Sponsorship
  • Speaking Engagements
  • Use of Photography
  • Work for Us

Go Deeper

  • Steady Habits Podcast
  • Economic Indicator Dashboard
  • Five Things

The Connecticut News Project, Inc. 1049 Asylum Avenue, Hartford, CT 06105. Phone: 860-218-6380

© Copyright 2021, The Connecticut News Project. All Rights Reserved. Website by Web Publisher PRO