Monthly Archives: December 2011

Many senior physicians would have one think that young physicians are like their children: easily distracted and absorbed by the growing culture of electronic connectivity. These physicians fear that younger doctors are in danger of ignoring clinical responsibilities in favor of the social obligations that accompany these devices: social networking, instant messaging and texting. And yet, the rapid adoption of tablet computers (predominantly iPads) and smartphones among training physicians represents the entry into the next stage of information technology in medical care. Mobile technology now permits instantaneous access to the most up-to-date pharmacopeias, practice guidelines, clinical trials and reviews, and also electronic versions of medical textbooks, training videos, medical calculators, and in some cases, electronic medical records. The adoption of the last wave of technological evolution, electronic medical records, has proceeded at an achingly slow pace, particularly due to the high startup costs that necessitate initial investment by a well-funded organization such as a hospital, group practice, or a practitioner with seed money. How can one balance the benefits of connectivity with the detriment that might come from distraction?

As is the case with many other solutions to problems encountered in the practice of medicine, the answer must come from within: the cultivation of greater self-discipline. One of the most important skills learned by interns and later refined throughout residency is the art of time and expectations management. The expectations and time demands imposed on training physicians by program leadership, attending physicians, chief residents, nurses, case managers, hospital administrators, and (last but not least) patients and their families are inevitably unrealistic and conflicting. For example, training physicians are expected to be in multiple places at once, frequently criticized for poor attendance at mandatory educational conferences or teaching rounds whilst simultaneously performing a necessary invasive procedure for patient care or discharging several patients timed to deadlines set by the case manager. Pagers are constantly invading the conversational flow of patient interviews, sometimes with messages urgent and other times mundane, sometimes informative and other times meaningless (the classic number page). New parties now have a greater foothold in the domain of attention of the training physician through electronic connections: loves ones, friends, and family. Physicians, previously unanimously choosing “dedication” and “commitment” to their patients in the form of long, isolating hours at the hospital over the cultivation of family and non-professional friendships, now have new methods that help maintain connections to the outside world during the breaking down and remolding process of medical school and residency training, a process that often involved the shedding of relationships. The current task at hand for the young physician is to develop the most appropriate methods of triaging the demands for their attention: focusing first on immediate patient care needs, attending to urgent personal matters when time allows, and delaying less time sensitive matters to off-work hours.

Underlying the criticism, however, is an unsustainable proposition: that technology is the enemy of the patient-doctor relationship. Over time, the impression has developed that computers and information technology draw training physicians away from the bedsides of their patients. In reality, the major factors that remove physicians from the patient’s room are the exponential paperwork demands (produced at the computer) and the processing of greater amounts of clinical data (read on the computer, in the form of laboratory values, imaging scans, or consultant reports and physician notes). In other words, the technology itself isn’t the problem: technology merely facilitates the information and documentation overload demanded by a litigious and defensive culture of practice. Technology can, in fact, bring physicians back to the bedside: doctors can update patients on their most recent lab values, check and update medication lists, explain their medical conditions in the context of an MRI or CT scan displayed on a tablet, use three dimensional models to explain basic principles of the function and dysfunction of individual organs (such as the brain or heart), and show them where to find trusted medical information sources on the Internet. Eventually, more digital documentation such as progress notes and discharge instructions will be easily generated by physicians at the bedside, minimizing the time spent at computer bays. In due time, both senior and training physicians will need to face the true problems within the practice of medicine and the delivery of health care that are underscored by the adoption of new technology.

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