He was my last patient of a long day. Fueled by a second cup of coffee, I opened the door to a pleasant gentleman with medical issues that had markedly impaired his quality of life for decades. His prior testing and treatment had not elicited clinical improvement or a straightforward diagnosis, which is a frustratingly frequent situation in gastroenterology. These are the challenging, yet frequently most rewarding, cases that doctors face.
My patient provided expansive answers to questions about his symptoms as well as his many stressors, so I quickly learned a lot about the life of this recently widowed, retired mathematics professor.
As I stood up to examine him, he offered a unique observation.
“So I see you’re not a fan of Pythagoras,” he said. “This is my first visit in years not from a right angle. Usually the doctor is facing the computer with his gaze fixed ninety degrees to mine.”
It was true. When talking to him, as with most of my patients, I had positioned myself directly across from him. Being a lifelong math nerd, I laughed and tried my hand at an appropriate response to continue the geometry banter.
“I only offer the hypotenuse to my patients,” I said. “Navigating the two legs of a right triangle is never as efficient and productive.”
The man smiled broadly and offered how he often had a palpable sense that his physicians have one eye on their computer, the other on the clock, and, if they had a third, it would have been on the door. I initially processed his comments simply as witticisms from a bright man who had spent his life immersed in academia. However, later that evening, with more time to contemplate, his words resonated as deeply profound and disturbing.
In my own practice, I always look directly at the patient. I can vouch for how witnessing an extra swallow, a quick wipe of the corner of the eyes, or simply a short avoidance of eye contact can sometimes provide invaluable insight into a patient’s condition. I recall observing one recent patient who, periodically and for only a few seconds at a time, would rub his forehead with his open palm. When asked if he was OK, he immediately proceeded to open up about a host of ongoing difficult issues in his life. This led to a productive discussion about the connection between the brain and the gastrointestinal tract and, ultimately, a much more effective treatment of his newly diagnosed irritable bowel syndrome.
For many, medical appointments have been marked on their calendars for weeks with loved ones anxiously awaiting the reports from these visits. Patients arrive with varying degrees of anxiety and trepidation, and deserve nothing less than an assessment that picks up on all cues. They deserve complete attention from their physician. But now, as monikered by my math professor patient, medicine is experiencing a “right triangle of care,” and the resultant distraction and detachment can prove catastrophic in a profession where the stakes are sometimes quite literally life or death.
Most analyses of medical care in the United States bemoan the macro issues — the dysfunctional insurance models, the inequities in accessibility to care, the pharmaceutical costs, and the motivations of third parties that now own most practices. But why has there also been this change at the micro level? That is, what has happened to the character of the over three million doctor visits each day in our country?
I do sense that my math professor’s experience has too often become the norm and has become accepted — almost expected — by patients. I can personally relate to experiencing the occasional office visit that, at best, can be described as functional. It starts with an online check-in a few days before the appointment, moves to answering questions on a tablet in the waiting room, continues to the physician immersed in the computer in the treatment room, and finishes with an online survey received before reaching my car in the parking lot.
I’m saddened by what seems to be a loss of connection between doctor and patient in the examination room that once reliably stemmed from empathy, focus and collaboration. To a significant degree, this is probably due to the element that has elevated detachment and loneliness in society at large: the computer, or more specifically in medicine, the electronic health records (EHR).
“I’m saddened by what seems to be a loss of connection between doctor and patient in the examination room that once reliably stemmed from empathy, focus and collaboration.”
While providing crucial access to a patient’s medical history, EHR has also contributed to an environment where completing computer templates and adhering to protocols garner more physician attention than the actual patient. In moments of full transparency, many doctors will admit that their biggest daily stress is related to completing EHR obligations — not to patient diagnostic and treatment issues. A 2017 study from the American Medical Association and the Dartmouth-Hitchcock health care system found that physicians spend nearly double their time on EHR demands as compared to direct clinical face-to-face time with patients. Quite simply and obviously, the EHR is not the patient!
As a medical caregiver for the past 29 years, I am aware that some reduction of physician EHR responsibilities would facilitate the movement of more doctor-patient interactions toward the ideal. Perhaps future AI innovations will alleviate some of this burden. But when a door is opened and a physician and patient meet in a private room, it is the responsibility of the doctor to make sure these connections happen. These interactions have, and always will be, the essence of medicine and cannot be compromised by providing care, both literally and figuratively, from 90 degrees. On this front, physicians can do better and patients should expect and demand better.
Michael Gerdis has worked as a specialist, a primary care practitioner and an emergency room physician, and is currently the chief of gastroenterology at Mount Sinai Doctors of Westchester. He has been passionate about health care since volunteering at the Children’s Hospital of Philadelphia as an undergraduate student at University of Pennsylvania, after which he attended NYU Medical School and completed a gastroenterology fellowship at LIJ Medical Center. He has experienced the profound changes in medicine that have resulted in a profession that has become almost unrecognizable. He sees what we have lost, why we lost it, and why it is imperative we get it back.
Do you have a compelling personal story you’d like to see published on HuffPost? Find out what we’re looking for here and ***@******st.com.” data-vars-item-type=”text” data-vars-unit-name=”69c81edfe4b06be0a3087627″ data-vars-unit-type=”buzz_body” data-vars-target-content-id=”https://www.huffpost.com/entry/mailto:pi***@******st.com” data-original-string=”KXDPcpZVJsN34C+6A2q/Ng==6f66TLGK1q4n0lFUgKfGYaRbbp0cc2E4NLm52DHXRvaobA=” title=”This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.” data-vars-target-content-type=”url” data-vars-type=”web_external_link” data-vars-subunit-name=”article_body” data-vars-subunit-type=”component” data-vars-position-in-subunit=”2″>send us a pitch at pi***@******st.com.
About the Author
