Paging Dr. Dilbert

I always thought being a doctor I’d be free from cubicle life.

Not so.

Our medical center spent more than sixty million dollars over the last six years to upgrade the computer system we use.

It’s a system we use for just about everything.

With it, we can admit and discharge patients, write orders for the tests and medications they need while they’re in the hospital, and even do most of the documentation and charting for their stay. (Interestingly, though nurses, therapists, and virtually everyone else uses the computer for charting, we doctors still handwrite our progress notes and put them in a paper chart.)

I’m no Luddite, and generally I’ve been happy with the transformation of our systems.  The upgrade is in line with the federal government’s push to digitize all things medical to improve efficiency, safety, and ideally, lower health care costs. Medicine is finally moving (like most other industries before it) into the 21st century.

Be careful what you wish for.  Mandates bring all sorts of unintended consequences.

First, we’re now tethered to computer appliances.  To perform any basic hospital function, an order needs to be sent via the computer system.  This is good in that all doctor’s orders go through one standardized entry point, and eliminates issues with horrible physician penmanship.  This is bad because the computer can hamper communication amongst the care team.

For example, before our reliance on the computer, we would usually talk to our nurses about our care plan, or any updates or changes in the orders regarding a patient.  In this way, we knew that the nurses understood what we were doing and why we were doing it.  Now, we enter our plans in the computer, and the nurses receive them through the computer, but the communication piece is missing.

Sure, we can and sometimes do still talk.  Nurses are empowered to call us when there’s a lack of clarity.  But something elemental has been lost.

Being tethered to computers has other downsides.  There’s a much higher demand on the hardware side of things.  If the doctors need computers to enter orders, and the nurses and other staff need computers to read the orders, you can see how this can create bottleneck.  The medical center has to invest in hardware, maintain it and upgrade it constantly.

In one of the more ironic twists, to combat the hardware bottleneck around the various desktops on the wards or outside of patient’s rooms, hospitals have invested heavily in Computers On Wheels [COWS].  These portable workstations can be pushed along to patients’ rooms where the doctors can look at data, enter orders, etc. and/or nurses can enter data, read orders, reconcile medications, etc.

Many hospitals still call their units COWS.  My medical center correctly realized that patients might overhear this term and think: “Are they calling me a COW?”  We’ve therefore changed the name of our COWS to “R-2″ units, a tribute to the little sidekick robot from the Star Wars series.  Sounds futuristic.  Sexy.  Cool.

“Hey R2, come here and figure out what’s wrong with this patient!”

“R2, save them!”

Wishful thinking, right?  But not too far off, perhaps, as computer simulations of patients for training purposes become more the norm at teaching hospitals.

One morning not too long ago, I walked down one of the hospital wards.  I saw half a dozen nurses sitting in the hallway at their R2 units, entering data and talking about their social lives and their schedules.

Where before they might have saved such chatter for the nurses’ station, they were now out in full force on the ward doing work at their “cubicles” and carrying on as if no one were listening.

A major downside of having computers everywhere is that there’s simply less contact with our patients.  Our tendency is to look at the computer for data before even embarking to the bedside to talk with or evaluate the patient.  And by this I mean doctors and nurses.  I don’t have data to prove this, but anecdotally I know that our increasing emphasis on informatics has made us more data-centric and less patient-centered.

Remember the term “pencil pusher,” and how in a world that values accomplishing things with smarts and brawn a pencil pusher was seen as a non-contributor?   I fear we’re becoming a profession of “keyboard krazies.”