PracticalDermatology

Someone once told me that, in the field of medicine, “No one will remember what you said or did, but everyone will remember how you made them feel.” Indeed, no matter the success of our medical interventions, the most important service we can provide for our patients is to show them attention. Medicine is an imperfect art, but one thing we can always deliver is an experience that patients feel good about when they leave the office.

However, it is becoming increasingly difficult to give patients an experience they can feel good about. That’s because a growing number of us spend a good deal of our time with patients hunched over screens typing in data. Over the last decade, the use of electronic and digital technology in medical practice has become the new norm, to the point that rapidly increasing majority of us are now using some form of technology to see patients. While technology offers several advantages and may eventually improve the efficiency of health care delivery, its increased use could have serious negative implications both in terms of our relationships with patients and within the spectrum of healthcare at large.

More pointedly, the patient experience is in danger of becoming purely automated, with a diminishing need and role for real interaction with a physician. From our perspective, however, as the landscape changes rapidly, it is important that we ask ourselves what kind of future we want for our field: Do we want our patients to become data points on a screen?

The Shifting Technology Landscape

Before examining the impact of technology on the patient experience, let’s first take a look at how technology has changed and in some cases improved the practice of medicine. For example, technology improves our ability to interact with patients as well as colleagues outside of the office. Of course, we should always be in compliance with HIPAA when engaged in any electronic communications with patients, but this may become a less muddled area as newer innovations allow for safer and more streamlined interactions with patients.

Newer models for the use of technology will likely be developed that enable us to maneuver within these interactions in a safer manner. Currently patient portals are cumbersome to use both for patients and physicians. Understandably, patients do not want to go through the hassle of signing up, logging in, and changing their passwords frequently just to have access to the portals. However, based on recent advancements that we’ve seen, it is very likely that patient portals, and technology to interact with patients more generally, will change for the better in the near future. There are apps in developmental stages that will allow patients easier access to portals on their phones. Imagine, for example, that you have an app on your phone that allows you to link to any of your doctors (dermatologist, neurologist, primary care, etc.) to schedule appointments or access information from recent visits. This would not only benefit the patient but medical practices, as well, particularly when it comes to interacting with other physicians and patients. This may well be a reality in a matter of just a few years, along with the development of a broader communication network that’s HIPAA-compliant that will streamline our communications with patients and colleagues.

Within the scope of Electronic Health Records (EHR), the silver lining may be the long-term prospects. For instance, the potential for data stratification and interoperability remains promising. And yet, despite the fact that interoperability has always been the most attractive aspect of EHRs, the government’s lack of focus on it is one of the primary reasons Meaningful Use has been such a struggle, not only for physicians but for EHR vendors, as well. If the program was designed with interoperability in mind, physicians would have been able to choose the app from which to run the EHR and made a selection based on what worked best for them. Instead, the government created an atmosphere of proprietary technology—the exact opposite of interoperability—that is only relevant to each individual system. Often times this has resulted in clumsy technology that physicians must adapt to use.

Fortunately, the direction of technology is integration. Tech companies are increasingly favoring user-friendliness and accessibility, which will hopefully result in a tech environment in which physicians can not only communicate with patients but access their chart and other documentation, which will lead to EHRs running more efficiently and increase satisfaction. Nevertheless, as new advancements in technology emphasize interoperability, the government’s mishandling of the Meaningful Use program only becomes more obvious.

Patient Interaction

As the quality of technology increases in healthcare, the advantages of an electronic age of medicine are becoming increasingly clear. However, just as the benefits are taking shape, so too are the drawbacks. While technology improves the efficiency of some aspects of practice and has been a plus for interactions outside the office, inside the exam room, it threatens the intimacy of the physician-patient relationship. Put simply, the interaction with patients is not as personal when the physician is looking more at a screen than the patient.

No doubt, as technology evolves, some physicians are finding more productive ways of integrating it into their patient encounters, but we will ultimately still be committing a decent chunk of our time looking at screens as human-to-human interaction dwindles.

In the past, the practice of medicine was much more personal and interactive with patients regardless of the specialty. Now, even the most personable doctors who are using technology must be looking at a screen as they search for things and check off data points for quality metrics. While it is true that physicians have always had other distractions (charts, tools, etc.), none of these had the power to nearly remove the physician from an interaction with a patient. After all, we have surely all had frustrating experiences with someone with whom we were trying to have a conversation that is buried in their phone.

Going forward, the challenge that all physicians will face is how we can continually incorporate technology while still preserving the doctor-patient relationship that the patient values. We now live in an era of Big Data, in which the government assures us that the compartmentalization of medicine will make healthcare run more efficiently and productively. Moreover, technology has made our knowledge base much easier to acquire, as all the information we could ever need is available at our fingertips. The application of that knowledge base is what’s really in question, however, and we have yet to see the implications of this play out.

The Importance of the Patient Experience

As technology continues to play a greater role in healthcare, arguably the best way we should approach its integration into our own practices is how it will impact the patient experience. We should always ask ourselves whether checking off boxes on a screen will help our patients feel better. Given how fast technological advances are coming, it has become easy to lose ourselves amid the activity and rely too heavily on it. n

Mark Kaufmann, MD is Associate Clinical Professor of Dermatology at Mount Sinai Hospital in New York. He is co-chair of the Dermatology workgroup for CCHIT and is on the Medical Advisory Board of Modernizing Medicine.