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

Tom Benzoni benzonit at GMAIL.COM
Thu Sep 29 22:26:07 UTC 2016


Might there be a cognitive bias or error in the group's thoughts on this
issue?
tom

On Thu, Sep 29, 2016 at 3:33 PM, Bruno, Michael <mbruno at hmc.psu.edu> wrote:

> 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/
>
>
>
>
>
> [image:
> 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
> <Michael.Grossman at MIHS.ORG>]
> *Sent:* Thursday, September 29, 2016 11:29 AM
> *To:* 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
> *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 <914-522-2116>*
>
>
>
> *Sent from my iPhone*
>
>
>
>
>
>
> On Sep 28, 2016, at 5:26 PM, . <0000000697ec7b18-dmarc-
> request at LIST.IMPROVEDIAGNOSIS.ORG
> <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
>
>
>
> -----Original Message-----
> From: Bruno, Michael <mbruno at HMC.PSU.EDU <mbruno at hmc.psu.edu>>
> To: IMPROVEDX <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> <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,
>
>
>
> [image: 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
>
>
>
>
>
>
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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