• The cost of information technology

    A few people sent this on to me, and so I share it with you. From JAMA, “The Cost of Technology“:

    No one was more surprised than the physician himself. The drawing was unmistakable. It showed the artist—a 7-year-old girl—on the examining table. Her older sister was seated nearby in a chair, as was her mother, cradling her baby sister. The doctor sat staring at the computer, his back to the patient—and everyone else. All were smiling. The picture was carefully drawn with beautiful colors and details, and you couldn’t miss the message. When he saw the drawing, the physician wrote a caption for it: “The economic stimulus bill has directed $20 billion to health care information technology, largely funding electronic medical record incentives. I wonder how much this technology will really cost?”

    © 2011 Thomas G. Murphy, MD.


    So it came as a stunning piece of feedback—not surprisingly out of the crayon of a babe—that his patients might be seeing him in a new way since the rollout of the electronic medical record. From my perspective of 20 years practicing and teaching primary care pediatrics and internal medicine and more than two years into juggling the needs of patients with those of the computer, this child’s drawing powerfully expressed the deep frustration and concern of many physicians, including me.

    No one is more for information technology in health care than I. But it’s important to remember that everything has tradeoffs, and that we need to work to minimize the potential downsides of electronic medical records in the practice of medicine.


    • You do notice, I trust, that this physician is caring for a whole family and that the family seems quite confident of the environment of care. They seem to see that the physician is doing the work of a doctor, that this doctor’s concentration on the computer is at their behest for their benefit. Nothing is ‘lost’ here, not from the patients’ point of view.

    • I find the anti-electronic records vibe here interesting.

      Here (Tokyo), my GP sits facing both me and his screen. His desk faces a wall; the patient comes in and sits at the left end of the desk as seen by the MD; the flat screen is along the wall; the patient can look to his/her left and see the screen. Everything goes through the system. Including his drawings of where the problem was. He types (and even draws) while talking to the patient.

      As a 6’2″ Japanese-speaking American, I figured he can’t forget me. But he can. We’ve had the “I play guitar in a jazz band” “I used to play drums” conversation at least three times by now. But he’s got all five or so years of my medical records in front of him every time he sees me.

      I’m sure that the reason he forgets our conversations is that he doesn’t even try since he relies on the electronic records. But I’d sure rather he forget my hobbies than my prescriptions.

      So I can’t imagine primary care, or any other medical practice that sees a relatively large number of patients, even beginning to work without electronic records.

      • My experience in Canada differs only in the location of my chair on the right! One thing that I’ve started doing, however, is to bring a single page document with my medical history on it to answer timeline questions that my family doctor and medical specialists seem to want to ask me. The aging of medical practitioners and their retirement mean that my history which stretches back to the early 1960s predates the IT systems of everyone on my current service team.

    • I am a practicing pediatrician with complete EMR . The implementation has not altered how I practice medicine. I would imagine that the physician depicted in the picture did not make eye contact before EMR. Don’t blame technology. The practice of primary care medicine is the ultimate “art of Medicine”.

    • O good Lord…my dr has been using electronic records for years. The laptop is on a rolling tray. She rolls her chair and tray close to me, looks into my eyes, glances down at my records and sees my WHOlE health picture.

      This child could have easily drawn a picture of a dr spending all his time recording his notes in longhand with no time to talk. Appt. over.

      The child’s drawing could be interpreted to say that the dr is personally having trouble adjusting to a technology that is omnipresent in our culture and has many benefits.

    • I agree that this says more about the way the Physician is using the equipment than about the equipment itself. The applications could also be improved to incorporate more graphics.

      I can image some creative implementations for Pediatric records. The screen could show a child and the Dr. could place checkmarks or “X’ on body parts that are in review.

      It’s probably better if the doctor focuses exclusively on the screen when entering prescriptions or complicated orders, but for the most part sharing the information has been helpful for me.

    • Seems to me this child must have been happy about their family visit to the Dr and simply expressed her pleasant time in a perfectly captured moment.

      The longer we resist the further behind we will be. In healthcare we should lead, not follow… to resist change in this advancing technology puts us behind those who are willing to advance and grasp vision.

    • There is simply no need (or excuse) for a physician to sit with his back to the patient and family members – whether or not there’s a laptop in the room. Like many here, I have sat next to a number of my docs as they show me what’s on the screen facing both of us.

      I’ve also sat in exam rooms with no computer but with docs who did not even attempt to make eye contact while staring down at my paper charts.

      • Carolyn…I was about to write the same thing. Seems the problem is eye contact and communication skills, not whether a computer is being used as assistive device.
        Perhaps this little girl’s picture is her vision of the end of the visit, when she’s happy it’s over, and the MD is simply sending an electronic prescription