Kumar, Rani K. MD
Dr. Kumar is an assistant professor of emergency medicine and the chair of the emergency department at University of Pittsburgh Medical Center in McKeesport, PA.
It was the peak of the day on a typical Manic Monday! I was a little tired as I started my shift, and I had a lot on my mind, administratively and personally. I walked into the room of a well-groomed, pretty, yet sad-looking 80-year-old woman. Her chief complaint: weakness. “Weakness,” as all EPs know, is mostly a no-win situation. Your workup is looking for that proverbial needle in a haystack. If patient's urine is not the culprit, you might want to order “one of each” tests.
I turned my computer toward her as I placed some CPOE orders. I knew this patient well from previous visits, and she knew me. She stopped her story abruptly, and then I knew something was wrong because she loved to talk. I asked her if she was OK, and she said, “I know how busy you are. I don't want you to get mad or yell at me.”
I held her hand, and said I would never yell at her. She became tearful, and told me she had tried to tell her son that the night before that she was weak. She explained that he was on the computer working on an important project. He told her to get something to eat, and promised he would check on her.
She told me how caring her son always was, but said he sounded a little frustrated and tired. “He must have forgotten to check on me last night,” she said. “I was embarrassed because I wet the bed. I felt too weak to get up and change the bed, so I lay on the wet linens the whole night.” She told me she was ashamed. She was a proud lady who felt her self-esteem wither away with this incident. She later called the ambulance because she did not feel right. She asked me not to call her son. “He has not been himself. Just too much pressure at work,” she said. “I don't want to be a bother to anyone.”
I knew she was right about the busy ED. I was very busy and appreciated short conversations with patients. I sheepishly left the room. I had little time to hold her hand or talk to her. I knew she probably had a UTI. I had ruled out neurological issues with my abrupt questions and examination. I ordered antibiotics, and her admission to the observation floor was rapid. My compassion skills were overpowered by my need to move in many directions.
The rest of the shift was tiring and chaotic. All EPs and advanced practice practitioners know those shifts where every second is crammed with the excessive unbudgeted load of the ED: documentation, placing orders, admitting patients, multiple calls to consultants, and computerized protocols that must be completed before the patient can be moved.
I have an endless relationship with my computer from the minute I enter the ED until I leave — and then some. I often tell my residents that the science of medicine changes each day. Yet the unchanged art of healing that comes from the comforting touch and attention of a physician goes beyond to mend a soul and body. I often say that the real healing energy to the patient comes not from the chemical formulas on the shelves but from the trust between the doctor and patient.
Our ED was recently cited by CMS because admission documentation was not always completed before the patient left the ED. Corrective measures were planned and piloted. The doctors and advanced practice practitioners are required to complete a power note on all admissions before the patient goes to the floor. The pressure built further as weekly reports of completed records were broadcast publicly to inject competition and efficiency in the physicians. More efficiency? Really?
Patient-physician time has been replaced by computer-physician time. Each moment in the day has an assigned next job to be done. Even personal breaks are often placed on the back burner. “Better communication through completed charts” improved gradually, but something had to give. That something was the time spent listening to the patient without interruption, to touch him kindly with sincere commitment. Who has time for that? So much to do! So little time!
Growing systems demands must curtail all interactions that cannot be measured. It's no wonder that behavior health issues are on the rise. The heavy artillery of computers and machines must be paid with human emotions. Move over, listening to and touching your patients; here comes documentation, length-of-stay, door-to-doctor time, RVUs, PQRI, and patients per hour that are vital for a good report card.
“Hug your patient” has been overtaken by “hug your computer.” Maybe CMS will encourage more healing moments with less electronic time, more time for patient restoration and less plans on the computer. Until then we can try to interact more with each other without our computers, iPhones, and iPads. Reflexively grabbing these devices in our car at a red light and during family time is a serious malignancy. The urge to respond to the ding of a text message grows ferociously, making us ignore the person right in front of us. These are grave symptoms of a deadly disease that is spreading its roots in our minds and souls.
This illness will be eradicated when we learn to use technology to create a stronger bond with patients, families, and friends. Till then, steal some computer hugging time for patient hugging and energize the soul to heal the body from inside out.
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