Introduction
Without warning, it creeps into the doctor’s office.
Without remorse, it disrupts the doctor’s schedule.
Without mercy, it encourages the doctor’s frustration.
What is the stealthy troublemaker?
It’s the Electronic Medical Record Meltdown!
Many healthcare providers can attest to the pure irritation of an electronic medical record’s temper tantrum right in the middle of a busy clinic day. Why do these temper tantrums have to occur when there’s a long line of patients in the waiting room?
An electronic medical record meltdown is what happens when the medical frontline reaches its breaking point in dealing with work-hindering technology. For example, in some electronic medical record systems, the number of clicks it takes to schedule a simple follow-up visit for a patient is ridiculous. It can feel as though you’re trying to order a nuclear submarine launch. And if you want to order a referral, it’s a few more clicks through a different window. In a medical system comprised of physicians and patients already starved for time, these little technological annoyances add up quickly.
In my view, many of these technologies aren’t suited to the healthcare provider. Also, physicians are being bombarded with requests and requirements to use multiple technologies at the same time. Medicine is stressful enough without needing to remember multiple logins or user interfaces. The result is money spent on something that physicians won’t properly utilize. Why can’t technology be built to better support, rather than hurt, the physician-patient relationship?
Technology’s penetration of the healthcare sector, compared to other sectors, has been relatively slow due to appropriate concerns regarding protecting patient health and privacy. But given skyrocketing costs in the sector, incentives to use technology to make healthcare delivery more cost-effective are increasing. In her TED talk, Nadjia Yousif, technology and financial institutions specialist at The Boston Consulting Group, noted that approximately 25 percent of the technology solutions, which companies originally consider adopting, are soon cancelled or sit unused.[i] That’s a great deal of money to be left on the table in a cash-strapped healthcare system. Therefore, all stakeholders in healthcare should be concerned with implementing technology in a manner that will benefit, rather than hamper, the delivery of healthcare.
How can we implement technology more effectively? It is when we deploy technology through a human lens that we can implement it effectively for both the patient and the physician.
While many healthcare stakeholders are focused on utilizing technology to solve problems, such as optimizing medical supply chains or securing health records against fraud, my interest lies in the more human need for the physician and the patient to connect. Currently, the physician-patient bond is on life support due to ongoing communication barriers within healthcare. In this book, we will explore how technology can break down these barriers and restore the element of human connection to the physician-patient relationship.
My Quest
In the fall of 1997, after reciting the Hippocratic Oath, I was inducted into the world of medicine. This is the line that resonated with me the most:
“I will remember that there is art to medicine as well as science and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”[ii]
As the years passed, my ability to give that warmth, sympathy, and understanding to the patient was severely degraded as a result of an onerous medical system that perversely valued economic incentives over patients’ health. To be fair, I didn’t know what I was getting into. At the age of sixteen, I was accepted into a combined undergraduate/medical school program. At the age of twenty-four, I had undergraduate degrees in economics and biology, along with a master’s in public health and a medical degree.
After medical school, I finished a neurology residency, took a year off to travel, and completed fellowships in epilepsy and sleep medicine. In December 2008, I began what was to become a decade as a private-practice physician. Originally, I had no intention of trying to solve the patient-physician communication barrier. After all, how could I, a simple physician in private practice, take on this whole onerous medical system? I did, however, decide to make a few changes in my own clinical practice.
In January 2015, I embarked on an adventure to learn about communication. I learned everything from observation skills in visual arts to stand-up comedy performances. My quest was to learn as much as I could from artists so I could better communicate with my patients.
During the summer of 2016, my search brought me to the world of design thinking, an iterative process that involves seeking to understand the user, challenge our assumptions, rethink problems, and look for new strategies and solutions. I was part of a diverse team with expertise in design, public health, and user experience, and our task was to design an item to improve the health of a lower-class neighborhood in Washington, DC. We looked at the points where technology and healthcare intersected, and after brainstorming we created a home-health-assistant module for patients: think, Google Home meets home-health aide. These informational sessions re-introduced me to the wonders of technology.
Here I must digress. In my teenage bedroom, the central light fixture was similar to the light fixture in the poker room of Star Trek: The Next Generation.[iii] As a teenager, I loved this television show—in large part due to a crush on Captain Jean-Luc Picard. However, Captain Jean-Luc aside, the technological possibilities presented in the show seemed endless. The ability to transport matter—as in, a living human being—off a spaceship onto a planet’s surface. The glasses that allowed Geordi La Forge, who was blind, to see. The hologram suites that transported people into new worlds. To me, the most fascinating scenes were those in the poker room, where the crew, despite all the technology surrounding them, were more relaxed, more themselves, and more human.
As a child, the intersection of humanity and technology always intrigued me, and during that memorable summer of 2016 I rediscovered that wonderment. While there is quite a bit of literature on how this or that new fancy advancement can deliver better payments or optimize the supply chain, my interest is still in how technology can be used to improve what is so lacking in medicine today: the human connection.
Now, I would not dare to be so bold as to pretend that I’m a technological whiz. I’m the last person to grasp how to work a new remote control. Many experts can eloquently explain the intricacies of technological advancements far better than I can. Yet how many of these technological experts have had to try to communicate complex medical conditions to patients? How many have tried to improve an individual’s health by prescribing behavioral changes? How many have done all of this while putting up with a medical system that, in the United States at least, is about as patient-physician friendly as a closed and bolted door?
Many clinical physicians working in academic research on digital medicine do a wonderful job. However, the realities of an average clinical practice are far different from those in academic centers. Given that I’m a regular physician on a mission to improve practical communication in her office, I offer a unique perspective that’s often lacking in the medical-technology discussions—that of an ordinary private-practice physician.
This Book’s Road Map
The first section of this book explores patient-physician interactions before, during, and after a clinical appointment. In the first chapter of this section, we’ll walk through current communication pain-points in a typical patient-physician exchange. In the following two chapters, we’ll explore technology’s potential to improve the clinical experience. In the fourth chapter, we’ll again walk through a typical patient-physician interaction, but this time we’ll consider how technology can improve patient-physician communication before, during, and after the clinical appointment.
The second section of this book focuses on what happens in the time between patient-physician clinical appointments.
In the second section, first chapter, we’ll discuss how technology can significantly enhance communication to improve patient education. Medicine has three legs: medication, surgery, and lifestyle change. Lifestyle change is an area where technology can make a big difference: it can help to improve patient health outcomes by improving patient education. After all, no matter how effective the patient-physician appointment seems to be, what’s the point if the patient doesn’t follow the medical treatment plan between appointments? In the next chapter, we’ll consider an effective physician-patient communication model in a typical patient-physician scenario. Finally, we’ll frame the patient-physician relationship within the larger technological forces shaping our future. It’s important for physicians and physician leaders alike to deepen their understanding of technological advancements that will affect healthcare in the future.
I’ve written this book for physicians and medical leaders, but technology professionals may find this book useful in developing an acute awareness of how physicians regard technology and of how the growing impact of technology can influence patient care. However, since the book is physician-focused, the emphasis is on the clinical application of general technology concepts.
Technology’s Advancement
Technology is changing exponentially. In fact, the technology references in this book may be out of date the day it’s published. However, the concepts in this book will live beyond the status of any particular technology. For example, whether you’re introduced to medical scanning by a simple x-ray, a CT scan, an MRI, a PET scan, or a functional MRI scan, the concept of imaging a body to help with diagnosis and treatment is still the same. Similarly, no matter what technological medical interventions you’re using, the theoretical concepts raised here will still be relevant.
A Thing of Beauty
The physician-patient bond is a very strange creature. As physicians, we may feel as though we’ve won when our patients’ health improves. And we may feel as though we’ve failed when our patients’ health declines.
As I’ve matured as a physician, I’ve come to realize that what’s most important is not to address symptoms but to heal the whole patient. When a physician truly connects with a patient and can observe how a patient overcomes individual struggles, it’s an inspiring experience. If a patient is truly healed and hasn’t simply had their symptoms addressed, the physician-patient bond may blossom into an exquisite masterpiece, no matter how long the relationship lasts.
Therefore, to reinstate the beauty of the human connection into the patient-physician bond, let us boldly go where technology and medicine have never gone before.
[i] Nadjia Yousif, “Why You Should Treat the Tech You Use at Work Like a Colleague,” filmed October 2018 at TED@BCG, TEDx, Toronto, Ontario, Canada, video posted December 2018, https://www.ted.com/speakers/nadjia_yousif.
[ii]“Hippocratic Oath,” Wikipedia, last modified January 5, 2019,
https://en.wikipedia.org/wiki/Hippocratic_Oath.
[iii] Star Trek: The Next Generation, created by Gene Roddenberry, TV series 1987-1994, accessed IMDb January 8, 2019, https://www.imdb.com/title/tt0092455.
