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Life in Emergistan

Bow Before the Glowing Screen

Leap, Edwin, MD

doi: 10.1097/01.EEM.0000552798.18316.84
Life in Emergistan

Dr. Leap practices emergency medicine in rural South Carolina, is a member of the board of directors for the South Carolina College of Emergency Physicians and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available at www.nursingcenter.com, and Working Knights, Cats Don't Hike, and The Practice Test, all available at www.booklocker.com, and of a blog, http://edwinleap.com/. Follow him on Twitter @edwinleap, and read his past columns at http://bit.ly/EMN-Emergistan.

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We spend far too much of our clinical time at computers. Our journals, meetings, blogs, and discussions all acknowledge the sad reality of our digital servitude. We didn't go into medicine for data entry, yet here we are.

Every day we're frantically trying to make life-saving decisions amid endless interruptions in chaotic environments. We are tasked to do so in a timely manner, all while spending quality time with patients, speaking courteously to consultants, arranging admissions and transfers, and simultaneously documenting every jot and tittle to please the electronic overlords who depend on our documentation for billing.

We have more computer issues than simply filling out electronic medical records. I was recently doing credentialing for work in a nearby hospital. Of all the places I have been credentialed in the past few years, it was honestly one of the easiest. Yet, to be financially credentialed required a moderate amount of additional computer time, entering information already in the system but in a different location.

Around the same time, I found I had lapsed in required online education for another facility where I sometimes work, not CME but internal requirements.

It was things like reviews of infection control measures, antibiotic stewardship, appropriate urinary catheter usage, central line sterility, corporate compliance, and the ubiquitous module on respecting our patients, which included this gem: “Be fully present and conscious.”

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Screen Exhaustion

I am a procrastinator, so I found myself hurriedly trying to meet a deadline for the modules. The program had more than 160 slides to review, and I spent a few hours, unreimbursed, staring at a computer.

I have friends in other locales who do the same. Required online education that takes a little bit more of our lives every day, every year, work that plops us down in front of a computer over and over, at home and at work, more work that dehumanizes what we do and leads to screen exhaustion.

Much of it is education imposed on physicians, not because they have a particular weakness or interest, not because they failed to meet their state or board CME requirements, but because someone decided it had to be done for reasons all their own. Maybe a corporation, maybe a consultant, maybe an education director.

It's like homework. My kids brought home a lot of homework over the years. Some of it was helpful; the majority was not, but it served its professional purpose, though the children had less and less time every evening to simply be, to enjoy the family, to play or read on their own. Homework was easily validated, a way for teachers show that something was being accomplished. Like our endless continuing education requirements, it was a metric that left chaos in its wake.

Admittedly, it isn't just work forcing us to bow before glowing screens. We voluntarily spend way too much time looking at our computers, televisions, telephones, and video games. At least we make that decision on our own.

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Hermetically Sealed

We are physicians, with enormously complex skills, but we are increasingly tasked with more virtual requirements, resulting in less time touching patients, watching pediatric patients breathe, talking with humans.

Sadly, maybe we're faced with this in part because it's believed to be a good life. I remember when I was growing up that I was told I needed a college degree because I could be injured and unable to work. I never thought about what would happen if I hurt my eyes or brain. Growing up a baby boomer, I believed that desk work was the cleanest, safest, highest of all.

As we've discovered to our misery, it is not. I love the physical nature of my job—walking, moving, lifting, reducing dislocations, placing lines, intubating, suturing, walking some more. I still do it, you still do it, but we have to hurry, and we can't relish it. We have to be back at the screen right away. It is our partner, our coworker, our tool, and our doom.

I came to the not-so-surprising conclusion that the ideal physician is one who sits at a desk so that charting and orders are done in a safe, timely manner without exposure to infections. The physician's hands are continually bathed in hand sanitizer, and he is in a hermetically sealed box that cannot be penetrated by anyone else.

How can we be freed from the screens? I have no idea, but a solar flare would be a good start.

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