The Electronic Medical Record

“The development of the child’s soul is connected indissolubly with his craving for the Thou . . .”  (Martin Buber, 1878--1965)

As a Child and Adolescent Psychiatrist, I witnessed the corrosive power of electronic media on children’s behavior, education and socialization.  Of all I witnessed, perhaps the most disturbing was the negative impact on the interactions between children and parents. Children and parents spoke less to each other, played less with each other, and looked less at each other.

Every day, I reminded parents of the importance of being parents; unplugging, monitoring the electronics, setting limits and having rules.  I encouraged children and parents to read together, play games together, have conversations together, be present, engaged and undistracted together.

Yet, at a time when I was informing families about the importance of turning off screens and making eye-contact, I was under pressure to turn away from my patients and towards a computer screen.  I was expected to embrace technology that promised to enhance and revolutionize medical care. Medicine had entered into the age of the electronic medical record, the extraordinarily labor-intensive and time-consuming electronic medical record.

An article in the Journal of the American Medical Association had this to say about the skills required of the future physician.  “In addition and most importantly, the physician will have virtuoso data entry and retrieval skills, with an ability to talk, think, listen, and type at the same time rivaling that of court reporters, simultaneous interpreters, and journalists on deadline.”  (JAMA, June 12, 2014 – Vol 309, No. 22, pg 2385)

I, a physician of the past and present, who happens to be significantly challenged in data entry and retrieval skill, was at first offended, next bewildered and then outraged.  Is this true?   Will this be the next generation of doctors? What about ‘bedside manner’, compassion, integrity, and problem solving, virtues I always thought defined the desired skillset of the physician?

I know when I was a medical student, my teachers worried about my generation of doctors. My teachers lamented that my generation was becoming enamored with laboratory tests and radiologic studies.  They feared we were losing the skills of taking a good history and a doing a thorough physical exam.  My teachers feared that laboratory tests would replace the physician’s skilled and observant eyes, ears and hands.  To a large extent, they were right.

Now, having been teacher to a new generation of doctors, I fear that as technology is embraced and becomes the norm, the young physicians will sacrifice yet another powerful tool for diagnosis and healing . . . the power of relationship.

Societally, relationship seems to matter less.  Where once I-Thou mattered, it is an increasingly I-it world.  I-Thou and I-it are concepts of dialogue and relationship from theologian and philosopher Martin Buber.  I-it is the nature of most interactions.  I-it interactions can be pleasant and friendly, but I-it interactions are impersonal, the exchange with one another often being a means to an end.  I-Thou occurs only when one is fully present in the company of the other, listening, engaged, undistracted.  It involves not only eye contact, but I-contact, full presence.

I have recently retired.  A new generation of doctors will determine how medicine will be practiced.  Will they practice I-it or I-Thou? Will they integrate virtuoso data entry and retrieval skills and still remain present, able to respond with compassion and humanity?  What’s at stake is not only how they will practice, but the example they will set, how they will model for the patients, parents and children who will seek their guidance.