Monday, December 29, 2014

Seeing Eye to Eye: Strugging with 21st Century Medical Ergonomics

Remember the days when doctors were literally and figuratively in your face?  You were the center of attention.  Now you must compete with computer screens that are in every examination room.  These devices are as annoying as the mobile products that children from every age group are carrying with them.  The urge to scold, "Look at me when I am talking to you,” is so very tempting.

Doctors over the age of 50 do seem to have better interior decorators or still get a thrill looking at their patients because the tables holding their computers are usually next to the patient's chair.  The doctor only needs to move his head a little to the side and back again to view both the computer and the patient.  The new kids on the block usually have their computers and tables on the adjacent wall.  This arrangement requires that they swivel their entire body around when they want to face their patient.  They normally do not sit facing the patient and swivel around to the computer.  Their focus is most often on the computer with their side and back to the patient as they occasionally look over their shoulder in the patient’s direction.

It is almost comical watching the younger doctors talk-swivel-type/type-swivel-talk for fifteen minutes minus the actual exam if there is one.  It is no laughing matter, however, when these medical acrobats make typing and judgment errors caused by fatigue or interruptions.  The pocket mini-cassette recorder that doctors used for dictation was much less intrusive and more accurate since records were transcribed by professional typists.   Even speech recognition software might be less intrusive and more accurate than the system in place today; but after experiencing computer crashes, I wouldn’t recommend it.

Older doctors seem to be as distrustful of computers as I am.  They will say, "This information is on the computer....  Is this correct?"  Sometimes it is not such as the time my primary care physician found a new disease listed that I did not have.  Another doctor checked with me when he found information that was new.  He was tracking changes made to his patients' records.  Younger doctors, like younger computer users, tend to believe that what they read on a computer screen is correct.  They are timid about changing anything.  If computers are networked, it does not mean that the information that one doctor puts into the system or removes from the system will appear on all computers in the network.  Why not is just one of those computer mysteries usually blamed on human error.  The most difficult information to remove seems to be the name of a medication that has been stopped by a physician or a patient.  Over and over again, I will be asked, "Are you still taking X, Y. and Z?" even when I have said, "No, no, no," month after month.  Computers have not only intruded upon office communications, but they have even changed office policy.  It is now a requirement that numbers such as blood pressure be typed into the computer by a nurse or technician before a doctor can talk to a patient.

I had many odd jobs as I worked my way through college including executive secretary, transcriptionist, and typist.  My typing speed is so fast that my computer sometimes cannot keep up with me and letters don't get capitalized.  I know that when I get tired or have been doing too much multitasking, I make mistakes.  I got so burned out one day that I could not remember where the letter, "a," was on the keyboard until I took a break and let my mind clear.  I have observed the leisurely way older doctors move from their patients to their keyboards.  They almost seem to be moving in slow motion.  They are so relaxed that you wish you could bottle whatever they have inside of them and take it home with you.  The younger doctors are more frantic and seem to be intimidated because what they are typing can be read by a patient looking over the doctor’s shoulder.

Even though I lack central vision, I still appreciate a doctor who talks to me face to face.  I appreciate even more the ones who ask, "What do you see when you look at me?"  I appreciate the doctors who apologize when they keep me waiting long after my scheduled appointment time and allow me to say, "You are always worth waiting for."  I appreciate the time that they take to do a thorough examination even if they take more time than office policy allows.   These men and women make sure that their surroundings and office machines do no harm.  The new kids on the block are being blocked from communicating with their patients on a traditional level.  They will have to be broken in or they will be broken by the technology that is harming some of them.  I hope the older doctors will teach their younger colleagues traditional communication skills and decorating methods.

Meanwhile, one patient, Nancy Davis, became so frustrated with the modern health care system that she wrote a book for patients like me, Lean on Me:  Ten Powerful Steps to Moving Beyond Your Diagnosis and Taking Back Your Life.  As Davis points out, patients no longer see eye to eye with their doctors or lean on them as they did in the past.  Her concerns and mine indicate that there is a major lack of trust now that all aspects of health care are being dominated by technology.  For once, I will say that technology is not the problem, ergonomics is.  Minor changes in the arrangement of furniture and computers in examining rooms, testing rooms, and operating facilities can be made to restore what is left of traditional health care.  Thanks to Davis, as I transition to a new generation of doctors, I am becoming an even more active participant in my health care and only work with those with whom I can see eye to eye and make full use of what sight I have left.

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