Doctors Are Talking: EHRs Destroy the Patient Encounter

Neil Chesanow

Disclosures

May 22, 2014

In This Article

There's no doubt that electronic health records (EHRs) spark strong emotions in doctors -- and many of those emotions are negative.

The gripes cover three main areas: One, EHRs have made the patient encounter far more annoying and complex than it ever was before.

Two, many physicians feel that EHRs take doctors who were trained to be independent thinkers and constrain their ability to make independent decisions, causing them to feel like data entry clerks, with a computer telling them how to practice medicine.

Last but not least, a large number of physicians feel that EHRs erode the doctor-patient relationship by creating a barrier between the two.

Three recent Medscape articles on EHRs are cases in point. Collectively they generated nearly 700 comments, many emotionally charged, from physicians and other providers. For a glimpse at what the fuss is about, read on.

Hate Dealing With Your EHR? Use a Scribe and Profits Increase

One might think that an article on medical scribes would be embraced by those disenchanted with EHRs, because scribes free the doctor from having to deal with the EHR, making it possible to maintain eye contact when interacting with the patient. Moreover, this article pointed out that scribes can be cost-effective, and it laid out the math.

But many doctors didn't buy it -- especially the cost-effective part.

"So the solution to the inanity that is an EHR is to hire yet another person and hope you generate enough extra income to pay for it?" one doctor asked. This was the most common type of comment.

"This (having to hire a scribe) is a practice that makes my blood boil," another physician wrote. "I'm just not buying it. One more unnecessary person to infringe on the patient's privacy."

"Seems that no matter what, the provider gets the short end of the stick," a doctor observed. "As it turns out, we have to hire a person to deal with the already expensive EHR. At the end of the day, we are still worse off than before we had the EHR forced on us."

"So adding another $25,000/year employee on top of the $80,000 for the EHR is the 'happy' solution?" a doctor asked. "I am not the government with unlimited money."

And one doctor declared, "I am revolting and staying with paper" -- a sentiment that several readers shared.

However, many doctors offered comments that were based on personal experience, and the tenor of those comments was quite different.

"Interesting to read most of the comments, predominately from people who do not have a scribe now or ever really looked into it," observed one doctor. "I have no interest in changing minds. But I have a scribe, and I added three patients per half-day in the first month, and more importantly, walk out of my clinic finished on time, without more charts to do. I really do have my family back."

"The best consult reports I have seen are from dermatology, where they use a scribe," another physician allowed. "None of the doctors leave any fingerprints on the computer; they spend time with the patient. The scribe being in the room is no different than any ancillary person who accompanies the physician during, say, a GYN exam."

The biggest employers of scribes today are hospital emergency departments. "In the ED, scribes are a godsend," commented an emergency physician. "After a break-in period, they have turned into an integral part of the team. We're not back to the 'good ol' days' of 2-minute documentation, but we're close."

Another doctor was even more impassioned in his support for scribes. "I have been using scribes for 5+ years," he wrote. "I would rather retire than work without them."

"I know several physicians who have begun using scribes, and they are quite satisfied," a physician remarked. "They have no difficulty generating the revenue to pay the relatively low hourly rate of a scribe. Additionally, they don't have to look at their computers anymore and can actually make eye contact with their patients. I have been considering a scribe myself and may go ahead with it now."

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