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Keeping a Focus on the Patient

by Abraham Verghese, MD, MACP

Physician and Stanford professor Dr. Abraham Verghese has written several books, including the New York Times bestseller, “Cutting for Stone.” Now, we at athenahealth are honored to have Dr. Verghese deliver the keynote address at our 2012 User Conference in April.

He was also good enough to join us on the phone recently to share some thoughts on modern medicine. In the first excerpt “To Live in the Moment of Patient Care,” Dr. Verghese spoke about the importance of being present for patients. 

Here is the rest of the conversation…

What are some of the promises and dangers of EHRs and HIT in the exam room?

I'm glad that we're in the electronic medical record era whether it's cloud computing or on a computer. The great danger is that in the process of recording this data we can neglect the patient.

In the hospital there's been a study suggesting that in a 10-hour hospital stay, four hours are spent charting and recording. I think all of us agree that that's probably too much time and so the great challenge for us is to find ways to be more efficient in charting. I think what athenahealth has done has really elevated that to a level where one can really focus on the patient and yet document, which is still very important.

The great danger in terms of the patient is taking an individual who's already feeling vulnerable, perhaps even disembodied changing into a paper gown and making them feel even further disembodied. To the degree that the physician can focus on them and use the computer as an ancillary tool, it succeeds in keeping that patient-physician relationship vital and sacred without it feeling like the real focus of attention is the computer.

What is your experience with care coordination—including possible limitations and a vision for how it can be executed better?

We're all aware of wonderful examples of how care coordination doesn't work well. You know there are so many opportunities during transitions of care for information not to be communicated. I think that too much of the conversation about hand-offs and transitions of care is focused on the health care provider when really the focus should be the patient.

If we put on the patient's perspective and view how it feels to go from hospital to home to outpatient visit to hospital, I think some of these conversations about transfer of care become colored differently. Too often the conversation is about hand-offs and sign-offs and those are all from the doctors' point of view.

The short answer would be that we have, in most systems, a long ways to go in coordinating care. It's perhaps the most difficult thing we do.

Some systems (yours it sounds like) do it very well. Certain systems are completely focused on the delivery of care to patients. The clinic model can do it very well but when an institution like mine, for example, has a mission that is two or three-fold, we're teaching, we're doing research and we're doing patient care. Sometimes those tripartite missions wind up actually being in conflict with each other because you are being drawn away from this to do that, from that to do this and there are three different missions.  So I think it's a continuing problem and I think we all marvel and look to athenahealth and other organizations to see how you do it.

It's an important issue for us all.

Learn about and register for our upcoming User Conference, which starts April 1, here in Boston.

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