I wonder if there is a difference between older and younger physicians when it comes to how much time we actually spend and would prefer to spend with patients. In 1984, fresh out of residency, I was the young man trying out a position in Livermore Falls, Maine. The two fifty-something family docs wrote their notes by hand standing up at the counter in a shared area. There wasn’t a whole lot of other paperwork to do.
Now, I read statistics from the American Medical Association that doctors spend more than 50 percent of their time with their EMRs, which at least to a degreee means away from their patients. I guess I’m a little slow, but it’s finally becoming clear to me why I am always behind on my charts.
Being old school, I have little patience for the fact that I am expected to tear myself away from my patients – worried, suffering fellow human beings – because the technology I’m required to use is pathetically clumsy and obviously not created by people like me who know and respect what I need in order to help my patients.
In the early years of my practice, nurses and medical assistants, like veterinary technicians today, were allowed to give medical advice and order tests based on common practice, verbal orders or “common sense”. In my Epic EHR, I have to “touch” everything, down to signing off on a “conversation” after my nurse has done what I asked her to do. And only I am allowed to give advice that any available grandmother would have dished out instantly and free of charge – if people had them around anymore.
I feel I’m in a culture clashing time warp.
How understanding can we expect patients to be when half of the time they hoped to spend with us, we’re interacting with a machine, ultimately for their benefit, but often in ways that are invisible to them.
I grew up before there were computers, smartphones or EMRs. But yet I think I’m more impatient with their inadequacies than younger providers who grew up playing video games. Not that I quite understand why they’re more tolerant of bad technology than I am, but I guess I expected that the future would bring more seamless, unobtrusive technology than it actually did.
And, speaking of computer games, compare them with today’s EMRs:
A Country Doctor Writes: 
There is good neurophysiological evidence that our brains are wired so that gazing at another person, furrowing one’s brow, and putting a “?” on one’s face—it makes a connection with a patient that thousands of words can’t do. We are still biological apes, although business want us to codify all information. This is true of many of the relationships in society, also, not only medicine. Can’t you remember swinging through the trees and having a friend pick the fleas out of your fur?
I retired 6 years ago as an F.P. because I could see that corporate medicine was killing medicine. The bean counters want every aspect to be by their book, that is to say on the algorithm like some pilot on a flight plan. Accountability (to them) means no deviations, time efficiency, documentation of mostly useless data. Doctors and patients alike are screwed.
It’s the EMR, to some degree. A lot of those “busywork” things in the EMR are what insurance mandates for billing. These are things some of us do after hours,when we are at home, evening and weekends, which is contributing to burnout. In the outpatient world, the ever-decreasing time allowed for face to face doctor-patient visits are driven by clinic administrators who are trying to drive up revenue for the clinic, in part because of the worsening insurance reimbursements, and in part because of needing to meet overhead for more administrative positions.
Medicine has changed, not for the better in many ways. The promise of the benefits of technology have proven to be lies to dig the trap to bury us in. The practice of medicine has been one of intimacy and trust but no longer the case today. AI has invaded everything because its seen as a cost saver and that has become the golden grail. Replace costly people with robots, no feeling, no intimacy, no trust. Congratulations administrators, wreckers of a noble profession, congratulations also to the lawyers who have been envious of our community standing for many years. Thanks also to the people who have gone into medicine for the wrong reasons, not for dedication but to make easy money with as little work as possibly.