Try an Undirected Office Visit, and Regain an Emotional Bond

Gregory A. Hood, MD

Disclosures

December 01, 2014

In This Article

No, the Primary Care Physician Can't Be Replaced

Within the context of national health workforce policy reforms, there are those who say that it is meaningless to fund or recruit any more primary care providers. I attended such a presentation in October. The speaker, a very prominent and justifiably respected individual, made this assertion, stating that within a decade IBM's Watson would be delivering all primary care. He asserted that primary care decision making is becoming so rote that human involvement would no longer be required. He used this video to supplement his points.

Respectfully, such projections, in my experience, miss the importance of stable, established, and ongoing human relationships in the successful delivery of healthcare. My partners and I, as the last group of primary care physicians that I know of in our community who provide 365-day inpatient rounding as well as access to our outpatient practice, have been aware of the reassurance patients feel by knowing that we are never far away, should the need arise for our services.

Subspecialization and the hospitalist movements have brought about useful and effective changes to our delivery of healthcare as a profession. Are we Luddites? Perhaps, but as a workforce, a healthcare system, and a nation, we have not been nearly as effective in balancing the intangibles that have been an inherent part of the art of healthcare since Chiron taught the art of healing to Asclepius.

Some physicians have tried an experiment in the patient encounter. They have laid aside the tablet, keyboard, or other documentation tool; looked directly into the eyes of the patient; spoken; and listened. From our youth or our nonprofessional lives, having a conversation with another person is typically an experience that each person has had thousands of times before. However, those who have taken up this mantle again in the examination room typically have felt a calm familiarity, but also a sense of newness and renewal.

A patient's life is like a newspaper. There are always many pages filled with stories of all sorts. We are accustomed to discovering these stories, or at least the ones that apply to our interest at the moment. We visit with patients all the time. However, it would be more accurate to say that we visit with their medications, their diseases, and the pieces of them that interest us. It's like tapping the internet to only read the articles that interest us. It's more convenient, more expedient when we are busy. We are always busy.

We're trying to do two things at once: treat the patient, and document. Put more accurately, we are paid to obtain information and record it. If the patient happens to do better as a consequence of our encounter, then more's the better. We're multitasking, always hurrying from one objective to another, one exam room to another.

The HIT networks are excellent at facilitating such work. In each visit, you're able to log straight into the information that you wish to retrieve or update. Because you know what you're looking for, you click straight to your data, interact, then log out (of course, for HIPAA security).

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