Curbside Consult with Dr. Jayne 8/12/13

There’s a physician I work with who is constantly calling for the death of the electronic chart. He’s completely convinced that life was better on paper, despite any attempts to convince him otherwise. I was trying to think of a word to describe him and “curmudgeon” was the only thing that really fit the bill. Often when I mention someone like him, people assume I’m speaking about an older physician who is close to retirement. This gentleman, however, is my age.

We both serve as faculty for the local medical school. He’s constantly mentioning how the students are much more facile with the EHR than he is. I’ve offered to spend time with him one on one, but he always refuses. I’m not sure whether it’s pride or some other factor at play. He can’t be worried about being left in the dust by some young whippersnapper since we’re age group peers. He won’t let anyone else help either – maybe he’s just embarrassed about his inability to effectively use technology.

I think he might also be embarrassed to let anyone see how his practice runs. His staff is not given the ability to work at the top of their skills and training. On the other hand, the medical assistants who room his patients are not held accountable when they fail to execute their roles and responsibilities as documented in the practice workflow or their personnel files. I often hear him make statements about “spending 20 minutes on the internet trying to find a pharmacy phone number” or “digging around for an accurate medication list.” These show that there are either issues with staff performing basic duties, how people use the EHR, or both.

Working under the same group practice organization, we have the same EHR with the same customizations, limitations, and frustrations. For some reason, however, I can see 40-plus patients per day in a primary care practice with top quality metrics and go home on time, where he is struggling with 25 patients per day and works hours each night at home. Other than medical school, our pedigrees are very much the same. We’re both certified by the same specialty board and trained in comparable residency programs. We’ve been in practice the same duration.

What makes the difference then? In my experience, there are a couple of factors at play. First, one has to have the willingness and ability to allow and enable the support staff to actually support the physician. This means not only ensuring they have the skills to do what needs to be done, but to make sure that tasks are performed properly. Case in point: he claims he doesn’t trust his nurses to take a blood pressure. I’ve told him a couple of times he can either spend the time training them to perform that task his way in a reproducible way or he can do the nursing tasks for the rest of his career. But if he chooses to do that work, he’s not going to see as many patients or finish the day on time. I’ve been in those shoes and the upfront investment in staff development pays off a hundredfold.

Second, success with the EHR (as well as in one’s practice and life in general) is impacted by the willingness to accept change. Some people just don’t do it well, but it’s a skill that can be learned. We all need to face that unless you’re willing to dump Medicare / Medicaid / insurance and go cash-only or concierge, change is going to be constant. Developing skills to manage the response to change is paramount to maintaining sanity.

Finally, there has to be a willingness to accept technology. Even if you identify as a Luddite, you have to understand that technology must play a role in healthcare if you’re going to stay in the game. I look at the transitions in other business sectors to see how they’re handling it. As a taxpayer, I recently received a postcard from my local school district. It was an annual notice that unless specifically requested otherwise, all communications are through the district website, email, and text messaging. Apparently they don’t even send home report cards anymore – parents must access them online unless they specifically request a mailed report card.

I was recently treating a patient for some wicked poison ivy and he mentioned that the ultimate bastion of outdoorsiness, the Boy Scouts of America, recently handled scheduling of activities at their National Jamboree through an app. He was overjoyed to find he had Wi-Fi in his tent and could charge his phone at the shower facility. (That’s a lot different from when I was a Girl Scout – I wonder if a cookie app is next?)

Back to my curmudgeonly colleague. He has a smart phone, he banks online, and I’ve certainly watched him shop on Amazon. We need to find a way to help him embrace technology in the workplace and understand that the EHR is not here to suck the life out of the patient-physician relationship or to wound his soul. Rather than resist, we need to look at data with a new eye, see the potential it has to help patients, and figure out how to work with it. It’s not just the young or the techies getting out there, either. When I finally signed up for Facebook a few years ago, do you know who I found had arrived first? My grandmother.

To work in healthcare, each of us has to embrace technology to some degree. Not everyone has to be able to manage a database or write code, but at a minimum, we have accept the fact that it’s part of our day. We can’t act like the world is coming to an end. Just a warning though – it might be. My newly smart phone-owning mother just sent me a text and used the word “selfie,” so don’t be surprised if the apocalypse is close behind.

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