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First, do no iHarm

In this post, I will be commenting on the New Yorker article “Why Doctors Hate Their Computers” by Atul Gawande, from November 12, 2018. It focused on doctor’s frustrations with the transition to Electronic Medical Records, or EMRs.

Learning about this it has been surprising how painful the transition process has been. I have heard similar complaints from friends in the field, but I did not know how widespread it was.

By the sound of it, it is hundreds of little reasons that make the doctors’ lives harder. For one, it is much harder to add a simple note to a patients’ file. There is a lot of unnecessary information  that needs to be filled out, and many of these fields are mandatory. Another reason is that the computer gives the doctor arbitrary limits, like they cannot view lab results from a week before because their window for viewing it has expired.

Yet another reason is that the user interface is not very user friendly. It takes several more clicks than it should to do any one thing. The list of complaints seem to be endless, and unfortunately the issues brought up in the article are likely just the tip of the iceberg.

The real customer for the system is certainly not the two groups that would ideally benefit the most — the doctors (and nurses and the like) or the patients. It has made the doctor’s jobs much more difficult without much to show for it. The strain that it puts on the doctors are felt by the customers as well. There might be a few advantages, but most are marginal at best.

No, the real customer is the creator of the EMR systems. They stand to profit from it quite a bit. The fact that they were ridged to any outside influence to make the system better shows their true motives.

The lessons from the implementation from this system most certainly do not only apply to the Electronic Medical Record systems. The article touched on one of the patient’s experience in his own life working in construction. He echoed one of the complaints of his doctor, which was that the automated alerts created a signal fatigue, and the solution is to do the old school way of going back to picking up the phone over using the computer.

When I read about the doctor not being able to submit a form unless all the fields were complete, I thought about when I worked at the YMCA when I was sixteen. There was an extensive incident report that took forever to fill out, so consequently, we never used it save for major events. Of course, these were still done on paper, but if a paper could get in the way of doing our job properly, I have no doubt a much more complicated system would as well.

This reading has not changed my opinion because I was already aware on the topic. I have read up on it in the Boston Globe, and I have talked about it with friends who are in the field. The New Yorker article just confirms everything I have already thought about it.

I was hoping the article might forecast what might come. As they are now, EMRs are awful, but they are here to stay. They have only been around for a little over a decade most places. This is just the natural growing pains we have to get through in order to get to something that benefits us all.


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