Sunday, November 21, 2010

Breaking the Nostaliga Habit

Imagine that you’re in an exam room waiting for your doctor. The year is 1961. What do you suppose happens when that doctor walks thorough that door, clipboard and file in hand?

Your answer is probably going to depend largely on your age. If you’ve managed to accumulate enough years on this planet, it’s possible that you remember being in a doctor’s office in 1961. Maybe you can even think of a specific doctor, though maybe the specifics of any one particular visit are a bit hazy over time. You might think fondly on a particular time when things, including doctors’ visits, seemed to move at a more reasonable pace. If you
’re in an age bracket that doesn’t remember a time without video games, however, your ideas about what doctors were like in 1961 are probably just a bit different. The doctor is just the conduit through which you can access the tests that will give you the results and expectant diagnosis. A doctor from a previous generation simply isn’t going to have as much knowledge access as a current one. If you fall into that generation between these two ends of the age spectrum, in that age bracket we call the Baby Boomers, you probably picture that 1961 doctor as a kindly old man in a crisp white lab coat. This is the sort of doctor who would understand and care about you personally. You imagine that the service and attention you would have gotten from the doctor would have been better.

The problem with all of these different visions of 1961 health care is that they don’t necessarily represent an "accurate" version of reality. Nor can we reasonably expect them to. Even those who remember walking into a doctor’s office in 1961 can’t reasonably be expected to legitimately remember that experience fifty years later. Doctors were't necessarily any more personal, or more invested in their patient healthcare in the 60s or really in any previous decade.

So when people are concerned that technology, like Electronic Health Records (EHR), is just going to get in the way of their care, that idea isn’t based on a real, honest assessment of past medical practices. Not to mention that all of it is going to be relative to personal experience. EHR are not going to make the doctor less interested in listening to patients and more concerned about the electronic data pad that gets brought around to each appointment. We often get anxious about technology getting in the way of one-on-one face-to-face interactions because we see it in our daily lives; or at least or perception of our daily lives. We catch up with old friends on Facebook rather than meet for coffee. We don’t stand around the water cooler at the office to discuss the previous night’s must-watch TV; we send forwarded interdepartmental emails instead. If we’re going to really understand the future of healthcare, we are going to have to let go of the idea that technology automatically distances us from each other as people.

That isn’t to say that technology is going to magically make things better either, but there are a lot of possibilities with EHR and the incorporation of technology tools into doctor-patient interactions. Let’s think about a new scenario, one where technology can enhance your healthcare experience.

Your doctor walks into the room were you’ve been waiting for a few minutes and greets you with a smile. The doctor then checks the iPad that she’s brought with her and says that it appears you’re here about a chesty cough that hasn’t gone away and asks you about other symptoms while listening to your lungs as you breathe in and out. She decides she wants an x-ray to rule out bronchitis, taps the screen on the iPad a few times and tells you that they are expecting you in radiology.

After you return from your x-ray you are shuffled into the waiting room again before your doctor joins you to go over your results. She brings up your x-ray on the iPad and says that according to the radiologist’s note everything looks okay, but you do need an antibiotic. She punches in a prescription, but frowns briefly and asks you about a drug allergy. Your record had prompted her to select a different prescription and wanted to confirm that you were indeed allergic as your records indicated. She prescribes you a new drug that you are unfamiliar with. She brings up a picture of the pills and use directions on the iPad and goes over your prescription with you.

She pulls out a stylus and signs the prescription electronically and lets you know that the pharmacy is completing your antibiotic order and that they assistant at the front desk is expecting you to schedule a follow-up visit in two weeks.

Nostalgia is often described as a wish for the past, a past that is more often than not idealized in our minds. In a way, nostalgia is a desire of a past that never really was. It’s a comforting feeling, particularly when we feel that our current frustrations are close to overwhelming. Nostalgia actually used to be classified as a disease, one that could send the new city dwellers of the industrial revolution back to family homes in the country to recuperate. We no longer thing of nostalgia as a disease to cure, but it is certainly something that we must overcome if we are going to greet the future of EHR head-on with a belief that we can ask for better healthcare. If we don’t, we just might have to face a reality where are worst fears are confirmed because we allowed things to happen just as we feared they would.

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