Part of the Transforming Life as We Age Special Report
Imagine you are a patient sitting with Dr. Suzanne Koven, a primary care physician: You want to share the story of what’s been happening to you medically and she wants to hear it. But as Koven wrote in a short essay for the health news publisher STAT, electronic health records make it harder for her or any physician to hold onto your story and treat you as a whole person.
EHRs, as they’re known, are the norm now. Doctors using them need to fill in a template on a computer screen by clicking on lists of symptoms and diagnoses. The result isn’t just a distracted conversation during your office visit. As Koven explained, the prefab lists and questions in an EHR produce a limited and highly fragmented picture of you.
An EHR “provides little sense of how one event led to the next, how one symptom relates to another, the emotional context in which the symptoms or events occurred,” she said. “It’s not well-suited to communicating a patient’s complex experience or a physician’s interpretation of that experience as it evolves over time.”
There can be negative health ramifications, she continued. When context is missing, it’s easier for a physician to over- or undertreat symptoms and miss underlying issues.
A medical record that abandons narrative in favor of a list does more than dehumanize our patients. It also hampers a clinician’s diagnostic abilities.
— Dr. Suzanne Koven
Two Tips for Being Heard
Many doctors recognize, and want to overcome, the downsides of electronic health records. Some, like Dr. Wei Wei Lee at the University of Chicago Medical Center, have championed the idea of a “golden minute” of technology-free time with a patient at the start of an appointment.
If your doctor hasn’t adopted that approach:
• Ask for a few minutes of no-screen, no-technology time for conversation at the start of your office visit. Use that time to tell the story of your symptoms and your needs as you believe it needs to be conveyed.
• Be ready for interruptions. Several studies have shown that physicians are prone to interrupting their patients and derailing their stories. In a University of South Carolina study, this happened after just 12 seconds, on average. If it happens to you, don’t be shy about turning the conversation back to your narrative. Say you’d like another minute to lay out your situation before moving on to your doctor’s questions.
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