Turn of the computer and pay attention to the patient!!!

Bruno, Michael mbruno at HMC.PSU.EDU
Thu Sep 29 20:33:12 UTC 2016


This is fantastic.  As they say-"a picture is worth 1000 word essay in the Wall Street Journal."

MAB


From: Wallace, Dr. Gordon[CMPA] [mailto:GWallace at CMPA.ORG]
Sent: Thursday, September 29, 2016 1:23 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Turn of the computer and pay attention to the patient!!!

In my teaching on engaging patients, I have successfully used the image below that Dr. Robert Wachter, author of The Digital Doctor, uses. A 7-year-old girl in hospital has made a drawing that shows her doctor facing his computer, and not her. The doctor is the one on the left. At least he is smiling!

http://www.everydayhealth.com/news/technology-making-our-doctors-better-worse/


[http://images.agoramedia.com/everydayhealth/gcms/Is-Technology-Making-Our-Doctors-Better-or-Worse-722x406.jpg?width=623]

Gord Wallace
Safe Medical Care
CMPA

From: Michael Grossman [mailto:Michael.Grossman at MIHS.ORG]
Sent: Thursday, September 29, 2016 11:29 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Turn of the computer and pay attention to the patient!!!


unfortunately these behaviors associated with EMR's seems to be expanding in the hospital as well as ambulatory setting. There is no "easy" method to bring this to your PCP's attention. However I would suggest approaching this in the following manner:



" I am grateful you concentrated on recording my medical history on or last visit, so I feel more comfortable on this visit to ask you to have a more personal in-depth discussion of my medical history and any social or behavioral issues you can identify to help me achiever better health balance. I have questions I hope you can answer for me and I  believe this will help you understand me as a person as well as a patient."



If I were your PCP I would respond positively to this request.



Michael Grossman, MD, MACP

Special Assistant to the Dean

Professor, Internal Medicine

Professor, Biomedical Informatics

College of Medicine Phoenix





________________________________
From: HM Epstein [hmepstein at GMAIL.COM]
Sent: Wednesday, September 28, 2016 8:48 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Turn of the computer and pay attention to the patient!!!
"The history." I love that answer!

Here's a recent story from a patient point of view. I moved back to NYC last year. I booked an annual checkup with a highly recommended internist who mishandled my history, cut me off when I attempted to answer her questions, rejected my description of an injury to my elbow, and so on. She determined I had a cardio issue (I didn't), had strained my elbow (I tore a tendon), misdiagnosed the cause of numbness in one limb (it turned out to be a spinal issue), refused my request for a GI referral for some serious and worsening symptoms and instead chose to handle it herself, ordering meds without ordering any tests. Of course this led to a horrendous six months of pain and delayed Dx and treatment. I found my own specialists and recently moved my care to a new PCP.

So, I met the new PCP this week. She was a referral from one of my specialists who said she was a great diagnostician. Luckily, this wasn't my annual check up. It was just an initial first meeting to get a couple of prescriptions refilled while I wait for my annual check up next month.

She spent the whole appointment with her face in her laptop. I came in prepared with my most recent blood test and a printout of my prescriptions, and I had had reports sent in in advance from the G.I., the cardiologist, and the orthopedist. She hadn't read anything. She asked me questions as they appeared on her screen, she recorded my answers, she didn't interrupt and I thought she listened to me, but she didn't retain a single answer or any aspect of the narrative so she asked me the same questions over and over.

When I come back next month for my annual check up, knowing that she now has my whole history on her computer, I plan to ask her to close the lid and talk to me first.

So, for the experts on this listserv, what can I say to her that will motivate her to look up and engage without turning her off?

Thank you for any advice or direction.

Best,
Helene

--
hmepstein.com<http://hmepstein.com>
@hmepstein
Mobile: 914-522-2116

Sent from my iPhone



On Sep 28, 2016, at 5:26 PM, . <0000000697ec7b18-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000697ec7b18-dmarc-request at list.improvediagnosis.org>> wrote:
When I talked to groups of physicians about making the proper Dx in spinal pain patients, someone often would ask "What is the one best Dx study to do if you could only do one?"  My answer - "The History."
PHil Benton, MD, JD
Atlanta
Phillip Benton
pgbentonmd at aol.com<mailto:pgbentonmd at aol.com>

-----Original Message-----
From: Bruno, Michael <mbruno at HMC.PSU.EDU<mailto:mbruno at hmc.psu.edu>>
To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at list.improvediagnosis.org>>
Sent: Mon, Sep 26, 2016 8:01 pm
Subject: [IMPROVEDX] Turn of the computer and pay attention to the patient!!!
See the attachment - I think this is an excellent article, echoing several threads discussed in this group over the past couple of years.

All the best,

[Description: Description: Description: \\hersheymed.net\files\Staff\M\mbruno\Signature2.gif.gif]
Michael A. Bruno, M.D., F.A.C.R.
Professor of Radiology & Medicine
Vice Chair for Quality and Patient Safety
Chief, Division of Emergency Radiology
The Milton S. Hershey Medical Center
Penn State College of Medicine
500 University Drive, Mail Code H-066
Hershey, PA  17033

Phone: (717) 531-8703
Fax:      (717) 531-5737

e-mail: mbruno at hmc.psu.edu<mailto:mbruno at hmc.psu.edu>


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