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October 16, 2014

When Everything Is Important, Nothing Is Important

This week we were told that a second “healthcare worker” tested positive for the Ebola virus in Dallas. At this point in the story about Ebola’s spread to the United States, the following thoughts cannot close the Pandora’s box that has been opened. However, maybe they can help us to think about how we care for patients, with and without the virus, in the future.

We’ve all sat in the doctor’s office and tried to make eye contact with the physician or other health care provider who is madly typing away at a keyboard as we try to tell our story in the midst of a barrage of questions. What used to be a conversation starting with “So, Mrs. Smith, tell me what brings you to the office today” has now become a checklist of mandatory queries and templated questions and answers. By the time you leave the office or hospital, your doctor might not know what’s wrong with you, but she will have documented whether or not you feel safe at home, if you have a latex allergy, if you’re interested in a living will, and whether or not you’re interested in donating your organs.

And this is closely related to what might have happened to Mr. Duncan when he first went to the emergency room in Dallas. Supposedly he related his travel history as part of his triage assessment and then the information didn’t get to where it needed to go. Is this any surprise? When the question about “have you travelled out of the country recently?” is buried in a sea of other questions and data about things that aren’t pertinent, how can it not help but get lost?

Electronic medical records can be helpful for some things and may end up coordinating patient care across multiple locations and providers. However, is it possible that our drive for implementation of these and our push for “population health” and all of the screening and data collection that entails has negatively affected physicians’ ability to concentrate on what’s important for the patient sitting right in front of them?

Maybe it’s time to re-think this universal move towards electronic records and re-focus on how to best take care of patients. Maybe physicians should be able to listen to their patients. Before it’s too late.

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