Thursday, December 20, 2012


Thanks and a tip of the hat to Christine Newsom, MD for sending me an editorial, “Virtual Grief,” from the November 28 JAMA.

Written by Dr. David Wu of the University of Washington’s Palliative Medicine Fellowship Program, the essay describes a significant blemish on the beautiful face of electronic medical records, EMRs. Dr. Wu reports finding an entry, inserted by a social worker, on the record of a patient he’d seen stating simply that the man had been shot and killed.

Dr. Wu hadn’t seen the patient as often as the electronic messages about him—lab and x-ray reports and so on. The man had slowly become virtual: unpresent in the flesh, he was represented by a computer avatar, like a character in a video game. In fact, Dr. Wu realized that as he spent more time with his patients’ EMRs than with them, they’d all gone virtual.

I haven’t been in medical practice many years now, so I’m unaccustomed to electronic record-keeping. When I recently examined a deceased patient’s chart, the nursing notes surprised me. Evidently nurses save time these days by checking a particular box to automatically write a note. If, for example, you want to enter, “Patient asks for more pain medicine than orders specify,” you can do so with a single keystroke, and then another part of the program adds the recommended course of action, “Physician to be notified.” Page after page exhibited only these un-nuanced notes, cleansed of the glorious human contact that must have occurred. 

In saving nurse time, computerized shorthand improves efficiency, which is, I guess, what healthcare’s about these days. A future archeologist reading this chart will surmise that our hospitals weren’t places that cared for people, but factories smoothly efficient in fixing disordered units, and especially in keeping records.

Dr. Wu writes, “Under this system, I’m not as good a doctor as I once was. What I mean is that I’ve come to prize what the system prizes: efficiency over human contact, computerized data over stories, virtual reality over authentic life.” Feeling compelled to inject some degree of humanity into the EMR of his patient, Dr. Wu wrote that it had been an honor to be the man’s doctor.

I hope his heartfelt comment doesn’t get incorporated into the next generation of this EMR software.

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