Are Computers Supplanting Physicians' Face Time?
These days, it almost seems as though medical care wants to proceed on its own without a human face—mine. A young person clicks on a computer box and the next thing I know she arrives at my office requesting an antibiotic prescription. She looks at me in the examination room as though the actual face-to-face examination is peculiar compared with the computer that prompted her visit. I culture her throat, which also seems outdated, and then, before much time elapses, we go our separate ways. She goes back to her computer and I go back to mine. Mine sends blood test and culture orders to the lab and a prescription to the pharmacy. Hers allows her access to her results. Human-to-human interactions give way to efficiency and computer interactions.
And the problem continues to get worse. A 2013 study showed that interns spend 40% of their time at the computer and only 12% involved in direct patient care.1
Recently one of my favorite disabled elderly patients came to see me, and I realized more than ever how medical care has changed—and not for the better. Her smile when she saw me meant everything, but it was fleeting compared with the amount of time I was compelled to spend at the computer, inputting orders to her electronic health record for her wound infection and arranging for follow-up care via e-mail. In fact, the amount of time I spend taking care of her has increased, though she doesn't realize it and instead feels a loss. She has diabetes, and as she approaches the age of 90, she has developed more and more complications. But these are dealt with by prescriptions and home support services rather than the face-to-face care we once both enjoyed.
The computer intrusion may favor efficiency, and it may even improve outcomes in crucial areas, but it does not extend the art of medicine, which is based instead on those ineffable moments when a patient looks at her doctor and sizes him up. Confidence in the doctor-patient relationship can take a patient across decades of illness and support many crucial health decisions.
In my experience, the older and sicker a patient becomes, the more crucial the doctor-patient relationship and the more important the communication with family members become. Here, too, the increasing fragmentation and mounting red tape that characterize health care are getting in the way of basic communication. This applies just as much to pushing the accelerator during acute illness as it does to taking your foot off the accelerator when death is looming.
With Medicare on the verge of approving payment to doctors for end-of-life discussions, I can't help wondering exactly when and where these discussions will take place. Will it be before or after the computer soaks up my time with documentation needs and prescription renewals? Don't get me wrong. I have always spent the time needed to know my patient's desires when it comes to end-of-life care. When would she want to be put on a ventilator and when wouldn't she? What would he want if, God forbid, he had a severe stroke or heart attack or developed widespread cancer? These discussions are no less crucial with the aggressive insertion of the computer into daily medical practice. But carving out the time for such a dedicated discussion is becoming more and more difficult.
It makes me wonder whether Medicare is, or whether it even can be, in step with the changing times.
— Marc Siegel, MD, is a professor of medicine and medical director of Doctor Radio (Sirius-XM) at New York University's Langone Medical Center and a Fox News medical correspondent.