Stuart R. Gallant, MD, PhD

Eventually, all of us need to talk to a doctor or a nurse, maybe about a headache, flu symptoms, or something more severe.  Ideally, we would like that to be a conversation in which our medical professional was fully present and focused on us—rather than glancing up from time to time as they tap away on a computer keyboard.  How can we help our doctors and nurses to win back a little time to pay attention to our medical story?  I have a few suggestions at the end of this post, but first let’s consider the problem.

The Electronic Medical Record

The electronic medical record (EMR) is the tool that doctor’s offices and hospitals use to keep track of your medical information (medical tests, imaging studies, medical procedure information, pathologist reports, immunization records, visit notes, physical therapist notes, nursing care notes, consulting physician notes, medications…).  It’s also the primary information source for insurance claims, legal claims, and efforts to systematically improve medical care delivery.  A full consideration of the EMR would require at least one massive tome, and I can’t do that in this post, so I am going to give you three key ideas about the EMR and how it relates to your care and that of your friends and relatives.

1. The EMR makes it a lot easier for doctors to get their hands on your test results.  Powsner and Tufte published a paper in The Lancet in 1994 that made the case that if the trove of medical test data could be arranged in a simple visual format, understanding a patient’s medical problem would be much easier for the doctor [1].  And, in fact, one advantage of modern EMRs is that they allow the physician to call up and graph data with relative ease.
2. Though the EMR helps doctors do their jobs, it also makes their jobs more difficult.  Some concerns expressed by physicians include:  time spent on data entry, incompatibility of EMR systems used at different hospitals, focus on patient billing, time lost from their personal lives as they labor to keep patient records updated, and ergonomic issues, including pain, resulting from time spent hunched over computers [2].  It certainly seems unfair and more than a little ironic, that physicians must visit physical therapists due to the pain inflicted on them by the EMR.
3. Because of the quantity of data in the EMR, doctors may not be able to fully review all the information related to a particular patient.  Part of being a physician involves bluffing—pretending that in a short period of time a physician is able to truly understand the medical history of an individual patient.  Indeed, one of the most embarrassing events in the education of a young physician is for a more senior colleague to ask about the significance of a particular test result that the young physician missed in the medical record.  Atul Gawande wrote an essay for The New Yorker in which he quoted a senior primary care physician regarding her attempts to confront the avalanche of EMR information, “All the letters that come from the subspecialists, I can’t read ninety per cent of them. So I glance at the patient’s name, and, if it’s someone that I was worried about, I’ll read that,” she said. The rest she deletes, unread [3].

The Patient in Wonderland

So, here we are in this world of medical data, part Nirvana, part Purgatory.  What is the individual patient to do?  I have three suggestions.

First, activate your on-line account with your healthcare provider.  Many healthcare providers offer a portal that allows their patients to access test results and medical reports, as well as to email their physician.  When tests are ordered, ask your physician why and what he/she expects from the test, then read the results and consider:  1) is it outside of the normal range for the test, 2) is it unusual compared to previous results I have gotten for that test, 3) how does the result compare with my doctor’s expectations?  Discuss the test results with your physician at your next visit or by email.

Second, create a medical summary form for yourself and/or your friends/relatives.  Attached is a Word template that you can fill out:

Given the technological sophistication of the EMR, why would a simple paper form be useful?

1. Consider how you meet your healthcare providers (doctors, physician’s assistants, nurses, pharmacists):  What is one major topic of discussion?  “What are your medications and allergies?”  This form allows you to recapture that time:  you give the form to them, they scan down the form, take a copy for themselves on the office Xerox machine, and move on to discussing more important matters.
2. The EMR is often poorly organized and burdened with redundant information.  Atul Gawande quotes a primary care physician as saying, the EMR “has created this massive monster of incomprehensibility,” referring to the high degree of redundancy and disorganization in many patient records [4].  This form makes “you” easier for a new doctor to understand quickly.
3. This form turns an ordinary physician into an EKG genius.  One of the challenges of EKG reading is that there is a lot of physics involved, and understanding what is going on can be a challenge—even for physicians in the Emergency Department who see a lot of EKGs.  A helpful trick is to compare the EKG taken when the patient arrives in the ED versus one taken previously when the patient was healthy and resting.  If nothing has changed, then there’s a good chance that things are okay.  If something has changed, the ED physician can call the changes out to the cardiologist.  By attaching your latest EKG, you are helping the hospital give you better cardiac care.  The same applies to the other lab results you provide—by giving the physician a baseline of comparison, any test he or she orders will have more value.
4. You can print the form out on one two-sided piece of paper and keep it in your wallet or purse.  So, wherever you are, you can always provide a snapshot of your health to your healthcare providers.
5. Security:  paper is not very secure.  If security is a concern, put a PDF copy on your phone so that you can text the information to your provider in an emergency.
6. Use your one piece of paper to discuss your health with your primary care physician:  “Here is my understanding of my health; is there anything else you think is relevant to be included on my one page summary?”  This could spark some discussion with your physician and help you understand your health better.

In my experience, this medical summary form is almost always well received by the doctors who I have seen reviewing it.  One time, I was in the hospital with a family member, and I did have an attending physician turn up his nose at the form, “We have all this information on the computer.”  But, to put that reaction in context, there were a half dozen other doctors and nurses on that same visit who were grateful for the work that the form saved them.  One doctor said, “This is nice, can I take a photo with my iPhone?”

Third (one final bonus tip), if you have a relative in the hospital, show up early and stay late.  Physicians conduct their rounds early in the morning (often 7am or occasionally earlier).  This is the best time to ask the physician what is going on and what the plan for your loved one is.  (Not a long discussion, just a quick update.  If you need more time, you’ll need to ask the physician to return later in the day when things are less hectic.)

But, don’t just show up early and leave.  If you can, stay all day.  This gives your relative moral support and shows the hospital staff that their patient is valued by his or her family.  Studies have shown that this affects the quality of care that patients receive.

[1] Powsner, S.M. and Tufte, E. R.  “Graphical Summary of Patient Status,” The Lancet 344 (1994) 386-389.

[2] Kroth, P. J., et al.  “Association of Electronic Health Record Design and Use Factors With Clinician Stress and Burnout,” JAMA Network Open. 2019;2(8):e199609.

[3] Gawande, A.  “Why Doctors Hate Their Computers,” The New Yorker, November 2018.

[4] Gawande (2018).

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