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As technology and the access to medical information have exploded worldwide, we may be ill-prepared to balance the technologic aspects of care with those of the art of medicine. At the core of all patient care is a personal bond between patient and caregiver. This relationship plays an important role in the process of both trust and healing.
With the introduction of computer-based electronic records (EMRs), online libraries, electronic imaging, and non-verbal communication such as texting and email, health care workers may be overwhelmed by technology and break from that human bond. As illustrated by a recent New York Times article, “As Doctors Use More Devices, Potential for Distraction Grows” and its resulting commentaries, patients sometimes believe that their caregiver is more concerned with their data, the so-called i-patient, rather than the patient in the room.
Recently, I wrote “Electronic Distraction: An Unmeasured Variable in Modern Medicine” in Anesthesiology News proposing that the key to addressing this problem of electronic distraction is teaching health care workers how to balance this highly promising technology with an unbroken focus on the patient.
We all know how the introduction of cellphones and the Internet has changed the picture of how medicine is practiced throughout the world, and these tools can give even the most rural health worker access to distant specialists, lab data and, of course, the world library of medical knowledge.
But how does the provider now approach the patient and keep him or her at the center of care?
First, the practitioner must learn to filter the electronic noise of his own personal life from that of his professional life. An excellent first step is to have a device for only professional relationships, be it smartphone or computer. This focused device is less likely to be distractive if it does not have personal Facebook or other social networks installed. The professional device can be loaded with professional email, messaging, and medical applications in place and ready to aid in patient care.
Another important aspect of integrating technology into patient-centered care is developing new human-to-human interactions when we care for patients and have a smart device or computer in the room. For example, when you enter an exam room, it is important to first focus on the patient, introduce yourself, and then state that you will also be interacting with an electronic device to better care for the patient. This technology etiquette is key to preserving the professional-to-patient relationship.
When I am working with students on how to interact with technology, I suggest they try to understand an electronic device as the third person in the exam room. I work with students on role plays that teach them to enter the exam room, introduce themselves, speak to the patient, get the patient’s medical history, then examine the patient. At this point, I encourage them to excuse themselves by making a statement like, “I will now enter your data into the computer so we can have a record of your findings today.” I then suggest the student complete the data entry, return back to the patient, and share any important data received from the computer such as literature on the disease, labs, imaging, and other consultations. I tell students it can be helpful to discuss with patients how technology has improved their ability to provide care. I also stress the importance of maintaining eye contact with the patients when speaking with them and getting data from them. I think it is this kind of conscious technology-to-patient interface etiquette that is essential in preserving the all-important professional relationship.
Some other key rules of my technology etiquette are: silencing devices when speaking to and examining the patient and telling patients that they are the focus, and you will be distracted only by an emergency alert. Including the technology as a member of the care team and ascribing to an etiquette about technology use can help mediate the distractions of electronic devices and help us better care for patients.
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