<p>My primary care physician’s practiced switched to electronic records 2 years ago, and now my doctor barely looks at me. She spends the entire appointment typing, and therefore looking at the screen. The only time she looks at me is when she’s actually doing the exam. I don’t think its a good thing.</p>
<p>My dermatologist, on the other hand, uses a scribe. The computer is at a table on the side, and as the derm does the exam she dictates to the scribe who types it in. This seems to work really efficiently.</p>
<p>However, if every doctor had a scribe I assume that would raise the cost of medical care.</p>
<p>When my husband was recently in the hospital, the nurses came in pushing carts with laptops on them. They recorded everything on the laptop, but they were still able to look at the patient and do the procedures that needed to be done.</p>
<p>I’m a PA student on rotations right now. Trying to learn a new EMR system every month has been interesting…I’m a fan of EMR because I like technology and think it can minimize error if the staff is well trained and familiar with how to use it, but definitely know some older docs that have had a hard time adapting.</p>
<p>The hospital where I’m rotating right now has a charting system that is driving me crazy. All admission H+Ps/discharge summaries, meds, labs, and imaging are in the EMR but everything else (progress notes, orders, etc) are still in the paper charts (I think the progress notes get scanned into the EMR eventually). I have a hard time reading the majority of the doctors’ handwriting in the chart so I feel like I waste a lot of time deciphering what their last note said, and someone has to manually put the written orders into the computer for the nurses, which is just completely stupid. In contrast, the teaching hospital where I’ve spent the majority of my time only used EMR and orders went right to the nurses, which makes a lot more sense. It wasn’t EPIC, but still worked pretty well.</p>
<p>I agree about docs getting wrapped up in the computer instead of paying attention to the patient during the appointment. I worked in primary care for a while and while most of our docs had templates so they didn’t have to type as much, I think some still got caught up in typing instead of paying attention to what the patient was saying. However, I rotated with a specialty practice earlier this year that I thought had the best of both worlds - they used EMR but didn’t take laptops in the room. They would use Dragon Medical (speech recognition software) to dictate the history and the assessment and plan after seeing the patient, then clicked through templates for review of systems and physical exam. I thought this was really efficient, as they were used to dictation from the pre-EMR era and it seemed to minimize wasted time clicking between different screens or checking a million boxes.</p>
<p>“do you know how much students did charge for this?”</p>
<p>They were paid a few hundred dollars as a token of appreaciation depending on how much time they put in. Son and other students had shadowing these doctors and they were asked if would like to help during the summer 2/3 times a week. They can put in half or full day. Most students would probably do it for free given the opportunity to volunteer or shadow. They were paid less than minimum wage if you divide the money they got by the time they put in.</p>
<p>"Do doctors realize that their patients feel ignored while they squint at a computer screen? "</p>
<p>Probably, but in many if not most cases, the patient is no longer “the (only? primary? paying?) customer”.</p>
<p>I am very careful about the positioning of the computer in my office, and in some settings use a tablet so I can just write free hand. I have often had people say “how do you write like that; without looking?”. To the kids I say; “how do you TEXT without looking?”. Practice!</p>
<p>in the 11 years i have used emr- i have the screen, desk, patient setup to look and talk directly to the patient. it takes some thought. now emr with telemedicine is hard to do without staring at the computer and the screen both at once!</p>