Atul Gawande jumps on the anti-EMR bandwagon, and it’s a very satisfying read:
There’s a techno-optimist view of how this story will unfold. Big technology companies are already circling to invest in IKS Health. They see an opportunity for artificial intelligence to replace more and more of what Rane does. This prospect doesn’t worry Rane very much; by the time technology has taken his place, he hopes to have set up a clinic of his own, and perhaps get to use the system himself. It’s not hard to believe that our interfaces for documenting and communicating will get easier, more intuitive, less annoying.
But there’s also a techno-pessimist version of the story. A 2015 study of scribes for emergency physicians in an Atlanta hospital system found that the scribes produced results similar to what my Boston colleagues described—a thirty-six-per-cent reduction in the doctors’ computer-documentation time and a similar increase in time spent directly interacting with patients. Two-thirds of the doctors said that they “liked” or even “loved” having a scribe. Yet they also reported no significant change in their job satisfaction. With the time that scribes freed up, the system simply got doctors to take on more patients. Their workload didn’t lighten; it just shifted.
Studies of scribes in other health systems have found the same effect. Squeezing more patients into an hour is better than spending time entering data at a keyboard. More people are taken care of. But are they being taken care of well? As patients, we want the caring and the ingenuity of clinicians to be augmented by systems, not defeated by them. In an era of professional Taylorization—of the stay-in-your-lane ethos—that does not seem to be what we are getting.
He doesn’t mention that EMRs are designed for billing, not for helping doctors care for patients. But other than that, it’s a great essay!
Matthew Loftus
Matthew Loftus teaches and practices Family Medicine in Baltimore and East Africa. His work has been featured in Christianity Today, Comment, & First Things and he is a regular contributor for Christ and Pop Culture. You can learn more about his work and writing at www.MatthewAndMaggie.org
