Technology at the Bedside

The major health care reform legislation passed by Congress last year requires physicians treating Medicare patients to utilize what is known as an electronic medical record (EMR). This is a computerized charting system that incorporates all notes taken when the patient is examined in clinic along with pertinent x-rays, lab data, imaging scans, prescriptions – basically one-stop shopping for patient information. Greenleaf has been using a system for a number of years now; it is excellent in terms of accessing patient information in a concise, readable fashion. To date, notes taken in the patient exam room have been done the old-fashioned way – by hand. Now Greenleaf is in the process of coordinating with Advocate Condell Hospital in implementing a new EMR that will provide a link to hospital services and truly coordinate patient office and hospital care. There are many advantages to this system, but the one significantly different factor will be that computers will be utilized in patient exam rooms. This offers a challenge in terms of maintaining the personal patient care that is a hallmark of Greenleaf's practice philosophy.

William Osler, M.D., one of the fathers of modern medicine, one said, "listen to the patient, and he will tell you the diagnosis." It is so true that the importance of patient history cannot be underestimated, and a significant component of that first encounter in the exam room is non-verbal. Much can be conveyed by looking at the patient – does the patient truly appear to be in pain, is he pale, does he look nervous, is there tension among family members who might be in the room – these are all factors that provide the physician with "clues" that will eventually help unlock the "mystery" or diagnosis. Eye-to-eye contact is essential in maintaining a steady response to questioning – where is the pain, how long has it existed, how can the pain be characterized. Responses to these questions as well as the flow of conversation is facilitated by looking directly at the patient. Greenleaf practitioners will need to work hard to ensure that the benefits of technology can be utilized without interfering with what constitutes the most basic element of patient contact. Our challenge will be to efficiently utilize our new technological resources while continuing to provide undivided, complete attention to our patients.