Mind Matters: For the record
OK, so we started using the electronic medical record (EMR) or electronic health record (EHR) a decade ago. This was supposed to make working faster, easier and obviously more legible. It instantly became a struggle entering every single bit of information on all “old patients” as well as all new patients as they came in for the first time to see us at the mental health center. This new bit of technological wizardry was supposed to make it easier to communicate with each other about patients, their needs, their treatment goals and plans.
Funny thing is, it was so intimidating at first that you were scared to death that you’d fall further and further behind on documentation if things were not completed right away. To that end, you had to see the patient, close the session or visit, say goodbye, close your door, and immediately turn back to the computer and type the note and complete the billing ticket while all the information was still firmly in your head. If someone happened by your door and just wanted to say hi or chat, you would begin to sweat if the exchange took more than thirty seconds. Flash back with me 10 years or so …
Them: “Hi there! How are you?” (Stepping into your office doorway as if they might *gasp* come in and sit down)
You: “I’m fine, thanks.” (nervously and pointedly glancing at your watch, while moving into position to body check their entry into your office)
Them: “Just wanted to drop by to chat. Haven’t seen you in a while, and …” (looking past you towards the two empty chairs in your office)
You: “Well, yeah, that’s nice, but you know, gotta think about that productivity percentage for the month. Got to get back to work, you know, got to type a note …” (gesturing towards the computer, which hums stupidly, not phased by any of this human drivel)
Them: “OK, OK, I see that you’re busy here. Maybe next time …” (backing away slowly, keeping their eyes firmly on you in case you decided to go kung fu on them)
After they leave, you close the door. Yes, I mean really close the door all the way until it clicks, and scurry back to your seat in front of the glossy screen that has now gone over to the Windows XP Professional screen saver. You key in your password and up comes the EMR screen with all of your pending notes. For now, you are caught up, but that was a close call. One more visit like that, one more frivolous conversation with another human being about grandkids and football season coming up and holidays and the end of summer and you are screwed! Human contact and conversation are the enemy! They must be controlled. They must be contained!
This is only my first patient and I’m already a full 5 minutes behind. Multiply that by 17 patients today, and, oh, my God! How many minutes have I already put myself behind because of that one little conversation?
Then you get the brilliant idea, the game changer, the one that will make your life easier by far, the idea that will get back that lost 5 minutes and then some. Well, in actual fact, administration gets this idea for you, but who’s keeping score, right? They decide that you will type the note while you are seeing the patient. Yes, that’s it! Type and talk! T and T. Get every important word down as it is uttered. You can do this.
And so you try. The next patient, an unsuspecting person with paranoid personality disorder, enters and sits in the chair under the window, the farthest one from you and your ... computer. You ask an open-ended question and he sits there, mute. Your hands hang poised above the keyboard of your laptop, now balanced precariously on your lap (where else, after all).
“Why are you recording me?”
“Oh, this?” you ask nervously, gesturing down at the laptop, which is now beginning to heat up and erase the crisp crease in your wool pants. “This is nothing, just a way for me to take notes while we talk.”
“Notes? Notes about what I say?”
“Yes, of course. Notes for my, I mean, for your electronic medical record.”
“Who gets these notes?” he asks, voice now high and reedy. “Who can see my thoughts on paper?”
“Oh, no, it’s not like that at all, you see ...”
“You can read my thoughts, so why should I believe that you’re not broadcasting them through that computer of yours. It’s wireless, isn’t it? I knew it! The government has tapped into your system here, and you are wirelessly broadcasting my every word and thought and wish to Washington, DC! Well, I never meant to ... They made me do it, the voices, they made me do it.”
This is rapidly getting out of hand, and a quick glance at the clock shows that it is now 9:48, twelve minutes until your third patient comes in, an 88-year-old lady with dementia and a medication list as long as your arm, all of which have to be entered into this damn electronic medical record. Oh, my God, I am going to be so behind ...
The suspicious patient rises from the chair as his voice rises to a squeak.
“You can’t let them know about me. You can’t!” he whines pitifully.
He comes towards your computer and, with one swipe, one quick lateral motion of his hand, he knocks the gray box off of your now-sweating lap onto the floor, from just above the factory tested height of 2 feet and 7 and 1/2 inches (the height at which they promise no data will be lost if said computer falls and bounces off a concrete floor, even one covered in cheap state-issued carpet) The laptop crashes, bounces once, the screen separates from the body, a loud pop is heard and the screen goes blank.
He looks at you.
You look at him.
He backs up and sits down quietly in his far away chair at the other side of the room under the sunlit window.
“There,” he says matter-of-factly as if he has just saved you from attack by a rabid dog. “Now. You were saying, doctor?”
Your immeasurable fear and panic and rage all dissolve in a moment as you are struck by the second truth that has entered your brain in the last hour. It is now 9:52 AM.
Since your computer is irretrievably broken, never to accept a keystroke again, you actually have the time to listen to this man for at least 6 more minutes. With no note to type, you might be able to open your door and see who happens by before you go pick up the elderly lady with dementia.
Why, the truth of the matter is, with your laptop dead at your feet, you will actually have the time to talk to someone, converse, exchange ideas. You might be able to hear about their plans, their hopes, their dreams, and yes, even their fears. You might be able to better connect and communicate with people – something the electronic medical record was supposed to help you do all along.
You pick up a pad and a pencil, lean back in your chair and look at the visibly more relaxed man across the office.