I practice medicine in the heart of Silicon Valley where everyday-people wear high-tech wearables, proudly display the latest handhelds, have smug, geek-party discussions about who’s more digitized and unapologetically immerse themselves in text chats throughout their dinner dates. I guess that has something to do with why I get defensive whenever I get asked why I still use paper charts. “Get with it Weisman”, they seem to say! “Don’t you know that you should modernize, stop killing trees and embrace the electronic medical record, or as it is know in modern parlance, the EMR? You’re a dinosaur!”


For the record, my practice is located in Mountain View, which is after all, ground zero for the technology revolution. And the seemingly ubiquitous technophiles who critique my practice, may be derisive of my outmoded ways because they believe I am old-fashioned, a Luddite, and incapable of changing with the times.  Yes, I still document my patient encounters with paper and pen. Ugh.


And worse yet, the detractors are convinced that I am guilty of providing suboptimal care to my patients by refusing to move from paper to a digital practice. Am I missing the boat? Needlessly hurting innocent people? OMG! LOL! Nothing could be further from the truth.


There’s no shortage of obsequious propaganda out there promoting digitalization of the medical world. So it’s hard to blame those who grouse about my ongoing use of paper charts for falling victim to all the hype and spin. Oh yes, I too have read all the endless, fawning fodder and heard all the sanguine soliloquies, touting the advantages of the digital chart.  


Pick up any medical journal and you will readily thumb through full-page ads, hailing the arrival of the EMR.  Beautiful people in crisp, white coats are commonly depicted holding sleek tablets, sitting comfortably at slick keyboards, flashing their subtle, smug smiles. I often open a newspaper and find yet another article filled with frenzied hype, about the oh-so-much progress that we have made in healthcare information technology. Poppycock! We are so surrounded by hysteria promoting the electronic chart that it has become harder and harder for me to defend my decision for failing to join the modern world.


So much has been made of the benefits of putting patient information on-line. In the face of all the propaganda it has been a challenge to hold the line and not “modernize” my office. Let’s face it, an EMR makes a lot of sense when you analyze all the potential benefits: Legibility. Efficiency. Saving forests. Easy data sharing.  Patient info 24/7. No messy charts. No file cabinets. Improved quality of care. Assisted decision-making.


Oh, and one more kind of a big thing: they threw a lot of money at me to “adopt” this Rube Goldberg scheme: a sweet, sizable bribe so to speak. Yes, I turned down a check from the U.S. government for $44,000! I mean who does that??? I must be a fool. Well, not to worry. I’m certain that turning down that tantalizing incentive saved me much, much more in valuable time and money. And I’m convinced that my patients benefited too. But that’s for a later rant. I promise to tell you all the details about this massive political boondoggle in a later blog.


Let’s face it.  Becoming a digital doctor just sounded too good to be true.  And it was.

“If it sounds too good to be true, it usually is” was a catchphrase used by the Better Business Bureau to alert the public to shady business practices since at least 1954. Well you know what? I’m here to tell you that the electronic medical record is in fact just another shady business practice. All the hype, all the touted benefits, all the fluff is unfortunately just too good to be true! It is just another beautiful dream that quickly becomes a false reality once you awaken.


The medical literature has been extremely critical of pretty much all of the commercially available medical record software for quite some time and almost from their inception. After all, these healthcare publications are actually written by end-users. And they ought to know. These are the providers of healthcare who get to use and try to make these systems work at the point of care. And until recently, I have noticed a real disparity between the glowing discussions about the EMR found in consumer publications and the studies reported in the medical journals that I read regularly.


Happily, and at long last, the truth about the electronic medical record is finally getting out there. No less than Bob Dylan said it best in one of his anthems: “The Times They Are A-Changing.”  So I’m sending a big shout out to Robert Zimmerman!! At the end of the day he was correct. Things are finally a-changing.  


There are two important reasons that motivated me to start writing this blog about the pitfalls of the EMR. First of all, I saw two patients this week who were grateful that I hadn’t gone digital. One simply thanked me for using paper charts.  “You’re old school” said a 76 year old woman with unexplained abdominal pain. “Thanks for doing things the old-fashioned way and not making me talk to your back while you type away at your computer.” The other was a 55 year old man in for routine cancer screening, who sat momentarily bewildered with his mouth agape when he saw me carry in the paper chart. “Good for you”, he mumbled. “I know that all the doctors I see hate having to type up their findings and you probably know that the patients hate it too. It takes so long to type it all in there. Probably many times longer than it takes to actually collect all the info.” He said it again for emphasis, “Really, I mean it, good for you!”


The second and equally compelling reason was the article I recently read on the Opinion Page in the Wall Street Journal.  The September 22, 2016 article was entitled. “Turn Off the Computer and Listen to the Patient” by Caleb Gardner, MD, a physician and resident at Cambridge Hospital in Massachusetts and John Levinson, MD, a cardiologist at Massachusetts General Hospital and Harvard Medical School. In their article, they argued that using a computer to document patient visits has damaged the doctor-patient relationship and ironically has interfered with the fundamental and important communication that is supposed to occur in that setting.  Bravo to you Dr. Gardner and to you Dr. Levinson.  You are both onto something big here. The patient must be the most important entity in the examining room and we should do everything in our power to make sure that nothing interferes with our patients’ preeminence.


Stuart Weisman, M.D


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