Respect the Patient!

I get angry and frustrated. There is a quote that say, "Don't just get angry! Do something about it!" What am I speaking about?

The center of what I do as a doctor is the patient. Therefore, it follows that listening to my patient, empathizing and trying to understand their concern is integral to caring for them.There seem to be more obstacles to doing this. For example, having to sit in front of a computer and click radio buttons and fill text books and click buttons to meet 'meaningful use' or satisfy some metrics qualification. Having to enter data as 'structured data' versus 'unstructured data' because the system cannot search 'unstructured data' to extract parameters to check off the provider meeting various requirements by payers, QI/QA metrics.

The patient tells a story. The doctor asks questions that add details, catalyzes elaboration of the story. It actually is quite like a story. There is a drama analysis structure called the Freytag pyramid which, simplified, describes drama as consisting of three essential points (with stages connecting them). They are (oversimplified): inciting event, climax, resolution. The clinical case would similarly have a inciting event (chief complaint), climax (acute catastrophic event, point of maximum symptoms) and resolution (cure, management, treatment). In between these points would investigation and evaluation (between inciting event and climax) and management or treatment (between climax and resolution.).

I used to be able to write my notes as narratives with a classic structure of Chief Complaints, History of Present Illness, Past Medical History, Social History, Family History, Review of Systems, Physical Examination, Results, Assessment and Plan. All medical students are taught this.

The structure has not changed, but with the advent of 'structured data', the note reads less like a narrative and more like a series of disjointed bullet points or random phrases grouped under headings.

Patients encounters have changed from being an opportunity for a patient to describe what ails them, into a data collecting opportunity and an chance to 'check the boxes' (colonoscopy? check; Immunizations? Check; Questions about Fall Risk asked ? Check; Depression screened for? Check). I wonder if patients don't feel like instead of having an open window to get a doctor's ear and seek his care, the doctor walks in with an agenda and list of things to do. Won't they feel like instead of listening to them, the doctor has a computer with blanks to fill out in a form, leaving precious little time to actually listen and examine the patient?

I write to create awareness of this quandary. I do get the need for having quality metrics and improving care, but have we become so overwhelmed with filling data into computer programs that we forgot the sensitive precious nature of the doctor-patient relationship? The eye contact, the healing touch (literally), the empathy and connection. The creating of a safe place where a patient will open his or heart and divulge important yet difficult to say information. What of these?

I'm still not sure how I'll do it, but I won't forget:

Respect the patient!