15 Sep Is Technology Helping or Hurting Your Relationships with Patients?
Increasingly, I’ve been asked to comment on how using an EHR impacts the doctor-patient relationship, and how to minimize disruption at the point of care. As is true of so many things we do in medicine, and the delivery of patient care, I think it comes down to three things: people, processes, and technology.
Let’s start with people. After all, delivery of medicine is fundamentally structured on the relationship between the patient and the medical professionals providing care. Care is defined as “looking after and providing for the needs of” or “to feel concern or interest.” This is the core of what we do every day, and it’s based on establishing and maintaining relationships. If you’d like to read a primer on good patient care and advocacy, I’d encourage you to read Leslie Michelson’s “The Patient’s Playbook.” Michelson explains that good medical care starts with your primary care provider, and the number one attribute of a good PCP is that they have to be someone with whom you have a personal relationship.
No matter how technology advances, it is imperative that we fight for, and promote, the fundamental relationship with our patients. If there are barriers to good relationships with your patients, identify and work to overcome them. It’s one of the reasons that so many people in our profession are disillusioned and unhappy at work. Those of us who have found solutions that work for us come home every day, having received some positive human interaction that solidified our commitment to medicine and patients.
Processes can drive you crazy, or make you feel effective and efficient. Creating a work environment where staff is happy, empowered, and each member of the team knows their value and role is very powerful. However, creating that environment requires that you take the time to view your current processes, reflect on what’s working and what’s not, and have the courage to change them. A great example that leads to everyone feeling frustrated happens at least once a day in my office. It is the patient who is scheduled for follow-up from an ER visit or hospital discharge for whom we have no information. Walking into that room without information feels like walking into your Organic Chemistry final without ever having gone to class. How can we turn that around?
Having a defined process, where the person who schedules the follow up appointment is also responsible for tracking down the ER or discharge report, changes the entire visit. Having a back-up process during the morning office huddle (prior to patient hours) ensures any missing information for a patient visit is reviewed and addressed before you walk in the exam room. While the morning huddle in my office was established during our Medical Home transformation project, it has become key to having a more efficient office with less surprises during the day, allowing us to deliver better patient care. This process change was not easy to implement, since staff has to arrive earlier, but it has been very worthwhile.
Technology is often the scapegoat for what gets in the way of the doctor-patient interaction. If done correctly, technology and your EHR should be enhancing this experience, not getting in your way. Information should be in front of you in a way so you can see what you need at a glance, instead of paging through a chart or needing to call your office staff to pull one. That requires some commitment to become familiar with where and how information is displayed, as well as how the information will be maintained and kept up-to-date. This also requires that users have a hardware device that enhances their ability to view and record information. If you have trouble using gestures on an iPad, don’t use it! Look at your office layout. Don’t set up a desk so your back is to your patient. Don’t use a wireless system if you’re in a cinder block office where connections are often lost. Your frustration at the technology will spill over to your interaction with the patient and the family. Be honest about how you think, how you work, and what will work best for you! (Note: This may NOT be the same for all physicians or staff in your office.)
Take advantage of the fact that as physicians, we have young families who love technology. Take their picture on a mobile app and show them how it is added to their chart. Let them contact you via the portal for non-urgent messages. Start plotting your strategy on how your office will embrace Telehealth to give patients remote access to you.
As physicians we understand that children grow and develop. Let your practice be part of it’s own growth and development to empower people through thoughtful processes. Use technology geared toward maintaining and improving the relationships you have with your families. We care for, and care about our patients. Let’s be flexible enough to continue to provide great care as technology pushes us forward.