Happy EMR Doctor Meets Unhappy EMR Patient

Twice in the past year I’ve had patients comment that they thought I was spending more time facing the computer than them. Now, granted, I’m still under the impression that the first guy, a thirtysomething techie guy who must have been facing some personal inner demons, (since he also later  told me I was saying things during our visit that I would never in my right mind tell anyone), but the second patient had a more understandable issue.  She asked me why I couldn’t just give her the lab results over the phone when all I did during our interaction was type the results into the computer notes and talk with the back of my head to her.

After I explained that I couldn’t get paid like that, compliments of her insurance company requirements, she felt more reassured and voiced understanding.  However, it was also a jaw-dropping, very important, lightbulb, ding-ding! moment for me.  Was this how I was actually coming across to other patients?  When I thought about it, I realized that in my rush to get into the room and not “be late” to the patient’s appointment time with me, I was not understanding that I spent most of the time staring at the computer screen reviewing results and then documenting the results in the note, which of course, took additional typing time.  I thought the patients valued an on-time doctor more than my face time, literally.

Later that week, I had dinner with a good friend who happens to be an orthopedic surgeon.  He recalled reading a study that showed that doctors who sat down and faced the patient were rated by patients as having spent more time with them, even when, for the purposes of the study, they had spent only half as much time (in minutes) in the room with the patient compared with another group of doctors who stood up during their interaction.  Human psychology is an amazing thing! and one I now use more often.  Since the time of my interaction with that second patient, I now usually spend at least 5-10 minutes reviewing documents and “pre-charting” in my office before I ever enter the patient room.  Do I spend about half the time (or less!) with the patients face to face?  Typically.  Do I touch the computer in the patient’s room anymore?  Not typcally.  Are the patient’s happier?  I haven’t had a complaint yet …

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC, as a solo practice in 2009.

About the author

Dr. Michael West

Dr. Michael West

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at doctorwestindc@gmail.com.

10 Comments

  • Great story. There’s definitely some learning curve involved in managing your charting in an EMR with having the patient interaction.

  • Great posting and self-assessment. The measures I’ve taken to help look patients in the eye include having a technician tell me a quick summary about the patient including any new test results as I enter the examining room and then scribe for me so that I can look the patient in the eye. I usually have to draw part of the eye exam (the optic nerve appearance or angle findings) but by then the encounter is winding to an end.

  • As a patient, I would really appreciate it if my physician would review my chart BEFORE entering the exam room. That way I would feel that the doc is prepared to meet with me. If during the visit, she needs to look something up on my chart, that is certainly acceptable, but it would be nice to have her sitting next to me so I see at least the side of her face while she’s using the computer. Physicians the have their backs to their patients are saying loud and clear to the patient, “My using basic manners do not matter when you are in MY exam room.” This is not the right message to send!

    This would go for my meetings with attorneys as well…not just docs. In no other professions can I remember going into a “meeting” where all parties weren’t prepared to start the conversation off without one party reading his/her notes first. It’s just plain courtesy.

  • The practice I go to is way ahead on the EMR curve; they’ve had a fully-electronic medical record for a number of years now. There’s a small (maybe 2′ x 2` or a little bigger) built-in shelf/desk in each exam room, with a rolling stool on one side and two chairs on the other. The MA or provider will bring a laptop in, set it on this surface, and it’s low enough that they can see you over it, and be facing you while they check your records and type in any notes.

    Works pretty well, as far as I can tell, although as a software engineer I might be more comfortable with someone typing into a screen while interacting with me. Still, it beats looking at the back of someone’s head hands down.

  • What I do is have the results printed out with a copy of the last note. I spend all my time in the patient room, sitting, looking at the paper results which the patient gets when they leave, as well as the last note. I don’t review outside the room. I want the patient to see the time I spend, but I am facing them and talking while reviewing the results. I get frequent compliments about how I spend much more time with them than anyone else has in the past.

    Is you now having to spend 10 minutes outside the room that you didn’t before becasue you have an EMR system that has changed your work habits?

  • Steve, yes, any EMR system I can think of adds time to the experience because you are not delaying the work of dictating until after the visit. I have tried a few times to walk in cold without having previewed the test results before speaking to the patient, but it usually end up with me looking or a least feeling like I am looking unprepared for the visit. It even got me in trouble once, and so I never do that anymore if I can avoid it. If there is something I have to look up in a reference text, then I like that time to do so before I see the patient.

    I think that your system can work okay, too, as long as the patient doesn’t have the expecation that you have already reviewed their tests before entering the room.

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