Forum
Feature
The practice computer –
a friend and a foe
While providing easy access to patient and illness information, the
computer can also get in the way of communication, writes Cliona Murphy
The switch over to ‘e-medicine’ was, in some respects,
easy. Many people have grown up with some sort of a computer, or else, knew a friend who had one. In my home, we
had an Atari, with two games – PacMan and Space Invaders. We loved it. Then as the years went on we got a PC.
In university there were computers everywhere, the internet, iPhones, iPads. Everything was online. Then on to
hospital medicine, hi-tech in many respects with MRIs and
bloods accessible online internally, but there still remains
a massive paper trail. And with that, daily ward rounds
lugging heavy charts and running to and from bedsides to
computer to check something else for the consultant.
So switching over to computerised medicine in general
practice seemed like the most natural thing in the world to
me. However, I was wrong.
My new job. Just me and the patient. Oh, and the computer. This hi-tech new aid to my practice. To ease the burden
of the paper trail. To aid easy access to records. To aid
person-centred care that we aspire to as GPs.
Despite previously being halted mid-rant (extolling on the
virtues of computers) by GP trainers and interviewers, and
asked whether computers could be a hindrance to communication, I never really imagined that I would be one of those
‘mmm hmmm’ and ‘oh yeah, I see’ people whilst staring at
the computer screen and trying to figure out the potential
current problem from their list of previous problems.
The computer together with the internet, really is a
modern wonder of the world. It is incredible that we have
instant access to all our patients’ medical records. Instant
messaging to patients, out to reception, access to consultant letters, medication lists, the list is endless. What I
find particularly useful is the ability to co-ordinate family
members, and by clicking ‘Family’ getting a list of extended
members. It makes for less awkward moments in discussion
about their fifth daughter who I saw six months ago.
However, a ‘brief intervention’ by one of my patients to try
and change my behaviour left me perplexed, embarrassed
and quite frankly annoyed at myself.
“Are you not going to listen to me anymore?,” she said.
Gulp. Cringe. Red face. I had to stop, regroup and consider
the reality. I had turned away to face the computer screen,
whilst she was talking. I felt like a little child who had her
computer unplugged because she wasn’t listening to her
mom. This was not what was supposed to happen.
The concept of the consultation, intertwined with this
patient interaction led me full circle past the cyber world. A
cyber world within general practice I could have inhabited,
if this amazing elderly lady with mild cognitive impairment,
and one of my favourite patients, hadn’t stopped me.
Communication is that word that is endlessly whispered
and echoed throughout the interviews and GP sessions. It
truly does have endless depth and dimension. Wednesdays in my life, have been transformed to a stretching and
moulding and deepening of my of understanding of communication, thanks to GP training.
Communication within the consultation is an amazing
concept. No plugs. No broadband required. No high speed,
high resolution, monster gigabits. Just use of the patient
to find out what is wrong with them. Back to the basics of
human interaction. Listening. Observing. Picking up cues.
Understanding. Empathising. Explaining what you think
might be going on, in plain English. Checking with the
patient, assessing their understanding and involving them
in shared decision-making.
In recognition of this, I ignored the computer for a little
while, only using it when necessary. I sulked. Annoyed that
the computer came between me and the very thing that
made me choose medicine in the first place – communication and people.
I read up, reflected on and integrated the different models
of consultation. I looked closely at the Calgary-Cambridge
consultation model. A certain weight had been lifted off my
shoulders during the consultation. I didn’t need to furiously
ask questions, I didn’t need to keep looking at the computer. We already have the medical knowledge and the patient
has the answers.
There is the potential for a fine art to be created. As such,
with wide brush strokes, and standing back observing the
painting unfolding, we can paint a picture in conjunction
with our patients.
I no longer felt the urge to dive into the computer for the
truth or to tell it all the latest news. Instead, I took solace in
gathering information, especially the patient’s narrative.
It goes without saying that the computer is there to serve
a purpose. Its use in management of the patient is both
useful and dependable. For information past, and recording
information for the future. It is a friend and a companion in
the lonely consulting rooms. However, it is the silent partner. It should not take the place of the consultation or any
part thereof but rather be used as a complementary tool to
enhance the consultation.
Cliona Murphy is a registrar on the Cork GP Training
Programme
FORUM July 2012 21
Computers-AH./NH 1
22/06/2012 11:49:03