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

Tom Benzoni benzonit at GMAIL.COM
Fri Sep 30 03:01:00 UTC 2016


Perhaps a gently asked question as to why so much time is spent staring at
the screen, followed by a WOMBAT (search WOMBAT, BMC,) may produce some
interesting data. And sympathy in place of attribution bias.

On Thu, Sep 29, 2016 at 9:19 PM, HM Epstein <hmepstein at gmail.com> wrote:

> Thank you Liz. I agree the process was a waste of her time. And mine.
> Perhaps they were shortstaffed that day. Perhaps she was just having a bad
> day.
>
> Luckily I have time to work on how to word the request. Hopefully she
> won't keep her nose in the laptop and I won't have to say a word.
>
> It's fascinating and disheartening to watch all the things I write about
> come alive right in front of me.
>
> Best,
> Helene
>
> On Sep 29, 2016, at 5:45 PM, Regan, Elizabeth <ReganE at NJHealth.org
> <ReganE at njhealth.org>> wrote:
>
> Dear Helen,
>
> What a disheartening story!
>
> For myself, I can’t imagine that the process you describe allows her to
> integrate the information and do the complex analysis that one should
> expect from a physician.  She was functioning as a scribe.  What a criminal
> waste of a physician education!  Maybe it was just to get the prescription
> properly recorded with diagnoses and pharmacy information. I still think
> that this could be work done by a nurse or medical assistant rather than
> the physician.
>
>
>
> I will be very interested to hear how your next visit goes.  It is
> possible that she will accomplish the right tasks but …
>
> I think that I would favor a direct request to her to talk with you and
> not focus on the computer.  I think it is somewhat likely that it will
> elicit anger but you may as well learn that earlier than later.
>
>
>
> Good luck,
>
> Liz
>
>
>
> *From: *HM Epstein <hmepstein at GMAIL.COM <hmepstein at gmail.com>>
> *Reply-To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> <IMPROVEDX at list.improvediagnosis.org>" <IMPROVEDX at LIST.
> IMPROVEDIAGNOSIS.ORG <IMPROVEDX at list.improvediagnosis.org>>, HM Epstein <
> hmepstein at GMAIL.COM <hmepstein at gmail.com>>
> *Date: *Wednesday, September 28, 2016 at 9:48 PM
> *To: *"IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> <IMPROVEDX at list.improvediagnosis.org>" <IMPROVEDX at LIST.
> IMPROVEDIAGNOSIS.ORG <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,
>
>
>
> <image001.png>
>
> 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* <mbruno at hmc.psu.edu>
>
>
>
>
>
>
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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