As a resident, I asked my husband what he thought a typical work day was like for me and his response was a conglomeration of various TV doctor shows. It involved a lot of walking around in large groups with white coats, reading charts that hung from the foot of patients’ beds, and gossiping in the supply closets and cafeteria. When I told him what my day was really like, he was shocked to hear how much time I actually sat behind a computer. After all, TV doctors aren’t spending their time typing since it would make for boring air time… but does it make for boring real life?
Electronic medical records have many virtues and in many ways have made my job easier. Patient’s vital signs, lab tests, and medical history are just a click away. I do not have to decipher my colleague’s handwriting anymore since it is all neatly typed and formatted. Even as a resident, a majority of my day was spent tied to a computer, whether it was during sign out where we checked our patient lists, or rounds where we entered orders, or during our work time where we followed up tests, typed notes, and re-entered orders. The burden of administrative work made time at the computer feel as essential as time at the bedside, and even as we participated in family-centered rounds, we dragged computers on wheels along with us. So many of my patient encounters were spent peering around or over computer screens.
As a primary care attending this is somewhat better, however, we still spend much of our visit in front of a screen. I strive each visit to balance the efficiency of charting while we talk with developing rapport in a naturally flowing conversation that is unconstrained by the computer templates. I try not to let the computer come between us or my back turn to the family as I type, however, I know that these things happen and that no social interaction that is filtered through technology will feel entirely organic. As much as I try to keep the computer inconspicuous, it feels as essential to my toolkit as my tongue depressors and stethoscope.
My patients have come to rely on our computers as well. Parents often say things like, “you’ll see xyz in your computer” or “I can’t remember, can you check the chart.” They like that their history is compiled, organized, and catalogued for them. Through a few clicks, I can read about their recent Emergency Room or sub-specialist visits, send prescriptions to their preferred pharmacy, communicate with teachers, and enroll them in services like Early Intervention or research studies. My patients can log in from home and view their own lab results or send me an email. When it comes to technology, instead of less, they are often asking for more!
I am thankful that I grew up with computers so that typing comes with ease and that integrating the science of computers into the science of medicine feels less cumbersome and more cooperative. When I imagined myself as a physician years ago, I never visualized a computer as an essential tool in my trade, but it certainly has become one. I try not to let it overtake our office visit though, and the kids in my office typically facilitate this with their (age-appropriate) short patience. When a toddler starts climbing the walls or a preschooler bores after finishing coloring, I leave the comfort of clicking through structured prompts in my history-gathering to engage children in fun open-ended questions. Eventually though, I have to return to typing to document everything in the record. So while I lecture my patients on limiting their screen time, I strive to find my own balance in doing so as well.