Abraham Verghese Shares Story of the EHR’s Negative Consequences With Broader Audience
In a recent feature piece for The New York Times, Abraham Verghese, MD, MACP addresses “the threat that electronic health records (EHRs) and machine learning pose to physicians’ clinical judgment – and their well-being.” Citing anecdotal evidence and quantitative analyses, Verghese describes the despair on both sides of the hospital bed and connects physician burnout and patient frustration to the way technology is currently being used in medicine.
Physicians, he writes, experience disillusionment not only at the start of their careers when “they are shocked to find that the focus on the ward doesn’t revolve around the patients but around the computers” but also as they enter daily practice and realize the EHR has turned them into “the highest-paid clerical worker in the hospital.” Patients feel equally dissatisfied, and Verghese says it’s because no one seems to be present. He writes, “In America today, the patient in the hospital bed is just the icon, a place holder for the real patient who is not in the bed but in the computer.”
It’s a story that Verghese has been sharing consistently in medical journals. He tells us that the article – “How Tech Can Turn Doctors Into Clerical Workers” – was a chance to connect with a broader audience: “I was happy when The New York Times asked me to contribute to this issue. The charge was to reflect on how medicine had changed from my perspective, and of course these changes, good and bad, and the nature of the practice of medicine, have been very much on my mind.”
Whether addressing a medical audience or a broader readership, Verghese uses the EHR as a cautionary tale to say we have to do better when integrating technology into patient care. He holds out hope that the rituals of the physical exam can be enhanced by artificial intelligence (AI) and machine learning and that AI can become a partner in patient care, creating a dynamic in which physicians use clinical judgment to apply recommendations it generates. For that to happen, everyone involved – clinicians, administrators, policymakers, insurers, entrepreneurs, etc. – must take a thoughtful approach, and they must care deeply about the result.
It’s strangely parallel to the behind-the-scenes view Verghese shared with us about the process of writing for The New York Times. It wasn’t just about the outcome. The process itself reinforced his faith in the people behind the story and the value of getting it right. He tells us, “What I really enjoy about writing for The New York Times, when they do invite me to do so, is to be reminded of their singular attention to the written word. It is reminiscent in a way of our attention to the body in the Stanford Medicine 25. The editorial suggestions that shape the piece are numerous, and we go back and forth, all in the space of a little over a week. By the second draft, you’re working in parallel with fact checkers who allow you to take nothing for granted. And just when you think you're done, then come the galleys and incredible scrutiny. I always come out of the process reminded of why it's a privilege to write for them and other such publications.”
Humility is an underappreciated skill in a time of global budgets, evidenced based approaches, and cost-containment. The bright, well-read, talented medical students who may lack humility are not uncommon.
Patient-centered care is an important aspect of the National Strategy for Quality Improvement on Health Care. As such, healthcare institutions are strongly focusing on the patient-physician relationship and the patient experience.
The editor-in-chief of Medscape, Dr. Eric Topol, visited Stanford to sit down and do an interview with our Dr. Vergese for the Medscape One-on-One online video series.
Peter Conrad, a sociologist at Brandeis University, spoke of the rise and fall of the medical authority in the doctor patient office encounter in his many scholarly articles. With the internet becoming the “elephant in the doctor’s office,” the dynamic of medical authority has certainly changed…