I am a psychiatrist.
I love my job(s).
I am a technology lover.
I love my MacBook, iPad, and iPhone 4.
Now, the dilemma that I need your help with.
I was covering a crisis unit this past weekend, as I do about once a month. This weekend was pretty standard-issue, in that I worked with about 14-16 patients admitted for problems from bipolar disorder to alcohol withdrawal to suicidal ideation to marital stress. I saw each patient once on Saturday and again on Sunday. New patient interviews and physical examinations (of course I can do a physical exam, what do you mean by that??) take from thirty minutes to an hour depending on severity. Follow up visits usually take ten to fifteen minutes. All documentation on this unit, at least by the physicians who cover on the weekends, is done by hand, the one exception being the ability to dictate a new H&P. I like to sit in my chair, the patient sitting across from me, looking directly at him or her as I interview them, watching for signs as well as listening for reported symptoms to best assess what is going on and how I can help. I usually have at least a rough outline of notes left by the regular treating physician or nurse practitioner to base my interview on, and I in turn will compile a list of notes from the weekend that I email back to the providers for their use on Monday morning as they start their week on the unit.
The problem?
Clipboard, (old fashioned, wood and metal clip, name in magic marker on a piece of white tape across the clip, indestructible, pen and paper based, unobtrusive as I speak with the patient, etc) OR iPad (sleek, cool, distracting ["Dude, do have Angry Birds on that thing?"], and a little harder to enter information on without being pretty obvious, at least in the moment.
I like to give my patients my full attention, and I can do that a good bit easier if I am jotting notes on a clipboard as we talk. I can do this very quickly and almost do it without looking down at times, since my note-taking sheet is the same one I've used for over twenty five years. If I use a laptop or an iPad, I have to divide my attention between the device and the patient, a compromise as I see it, and probably as they see it too. The rub here? If I jot notes on paper and want to email a nice readable typed copy to my colleagues later, I must spend more time entering that data into a device later. If I do it on the iPad during the interview or shortly thereafter, it is entered once and ready to email as soon as I get home.
This is one of the dilemmas that the availability of modern technology presents to those of us who work in various settings and locations, seeing patients of all kinds in all kinds of conditions. The trusty old clipboard is functional to a fault, unbreakable, can withstand coffee sloshes, and I can throw it in the back of my car for next time. The iPad is one cool device, lets me create gorgeous content and send data effortlessly, and I can listen to Greg Allman's new album while I work. Cool.
What do you think?
Which is better for the doctor? Which is better for the patient? I'd love to hear your opinions on this one.
Very interesting insight, here.
ReplyDeleteYou know I'm a tech lover as well, and have been tethered to my iPad since I got it, but still struggle to truly use it for good notetaking (see your points about writing in the margins, jotting something else over here, etc.) I'm hoping a new stylus will be the solution.
That aside - the point you're making here is really one of whether or not technology, in this case, is hindering or helping the professional. While in the long run it may save you time (assuming you can get past some of the nuances discussed above) your first priority is establishing trust and security with your patient. If the note-taking device becomes a pronounced object in the conversation, it hinders that relationship. While I love seeing medical doctors walk into the room with a tablet because it tells me they are working quickly and efficiently and my records and history are part of the conversation and not in a file cabinet somewhere, the experience with a psychiatric doctor is more intimate.
I also wonder about patients who are less technologically savvy...I would think that seeing an iPad for notetaking (especially if you're struggling to use it) could be jarring and could potentially hinder the trust. Might someone feel the electronic device means that what they share is less private?
Thanks for leading me to your post - it's a great conversation to be had and humbling reminder that technology, even for the sake of convenience, is not always the best solution.
Kary,
ReplyDeleteThanks for your unique perspective on this issue. For me, it still makes more sense to use the iPad for mostly consumption, watching, listening, and researching, and to keep doing my on the fly notetaking the old way.
It's a fun time to be alive, isn't it, being on the cusp of all this change?
Thanks for reading.
Greg
It depends, for the medical providers who are adept with the equipment, it's fine. When they're not, it's incredibly distracting.
ReplyDeleteThere have been times I've walked out of a docs office not having addressed what I'd really needed to because they were struggling so much with the program.
that's not a good thing
That being said ... how does one become adept with the technology if they are using the clipboard ?
I think they are going to have to teach students from the very beginning to be comfortable with this new tech gear, so that it is just an expected part of their interactions with patients much like stethoscopes and reflex hammers.
ReplyDeleteGreg