None of you remember it, but doctors didn’t always perform physical exams and their notes were very basic. Note complexity grew when exams were introduced a couple of centuries ago. With the plethora of diagnostics tools and techniques now, the note has taken on a life of its own, and exists for reasons beyond the patients’ health. In visits today, it is common for doctors to touch a computer more than their patient. What are the implications of this?
This question is the core of ‘The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Digital Age,’ by Dr. Robert Wachter. There are profound advantages to compiling better notes, but despite many years put into creating a robust electronic health record (EHR) system, one that lives up to practitioners’ and patients’ expectations doesn’t exist. There are many reasons why. One is that EHR system designers typically don’t receive input from end users, so the systems don’t even provide the basic functionality of an Amazon or Netflix website. But to be fair, the EHR industry is making strides to improve system usability. No matter how good the system is though, reliance on the computer causes problems, that without it, would have been extremely unlikely.
Dr. Robert Wachter is chairman of the Department of Medicine at the University of California, San Francisco, as well as Chief of Medical Service and the Division of Hospital Medicine at UCSF Medical Center. Modern Healthcare magazine named him the “most influential physician in the U.S.” He has authored six books and over 250 articles.