I have the great privilege of being a medical
educator. Every day, I have an incredible time working with internal medicine
residents at their continuity clinic, teaching the art of ambulatory medicine.
Our
working environment here is academically rich and fulfilling. The name of the
legendary Dr. Martin Leibowitz (an iconic figure in ambulatory medicine here)
stands outside our conference room as a constant reminder of how medicine is
practiced and taught.
There is a large oval table at the center of
the conference room, constantly surrounded by venerable attendings,
interspersed with curious residents, discussing all the difficult cases of the
day. There is the constant buzz of organized chaos like a stock exchange that
is addictive and keeps things fun and enjoyable.
Although
this positive vibe has never changed, the working environment has transformed
since I first joined in 2009. The conference table used to be littered with
text books like Harrison’s, Netter and a variety of dermatology books. In
between the people and books sat heavy, tattered orange colored paper charts.
Some were just a few pages, some hundreds, all documenting
a litany of complaints, physical exam findings, test results, insurance
documentation, medication lists and well thought out plans by generations past
of neophyte doctors.
Blue,
black, red, green ink on yellow oxidized pages, all fascinating yet often
illegible. My intrigue with these historical documents quickly faded, and
the burden of having to flip through hundreds of abstruse pages became quite
frustrating. The sight of these bright orange charts piled on my desk at the
end of the day, became a nauseating reminder of
the inefficiencies and dangers of paper documentation. Our electronic
medical record (EMR), slated to be release 6 months after my start date, could
not come soon enough.
When
our EMR era began, it was a cataclysmic event. The process of seeing a
patient with the computerized elephant in the room was a culture shock for some
the attendings and residents. But we integrated slowly, utilizing a
light schedule, and a lot of one to one attention for our residents.
In 2
years we overcame a lot of the initial technical problems and are on our way to
making this a very successful transition. The hardest part of this change for
me, had nothing to do with my personal battles with the EMR. Rather, the
presence of the EMR created an entire new domain of education I have to provide
for my trainees.
In
addition to medicine, I find myself teaching how to create macros or imbed
digital pictures into the electronic record. I’m teaching how
to incorporate a myriad of digital tools to better care our aging
complex population. It’s become clear that my role as an educator goes beyond
teaching classical medicine.
It also
involves teaching how medicine will be practiced in the future utilizing
technology such as social media and an EMR. As an advocate for the advancement
of technology in medical practice, I feel fortunate to have an audience of
bright trainees to share my enthusiasm about the future of medicine.
But
this technological leap in our practice has had a price.
Although
the placard of Dr. Leibowitz remains steadfast, the working environment has
drastically changed. The conference table often sits empty, replaced by several
desktops sitting at the periphery of the room. All the textbooks stand neatly
stacked in a corner, collecting dust, as Google images replaces dermatology
books, and online resources replaces most texts.
The
sound of vibrant debate and chart perusal has been replaced by the clicking and
clacking of keyboards. Whereas in the past, 50% of my encounter time would be
spent discussing each case, and the other 50% seeing the patient, my attention
is split in three ways now. 33% each , for patient, trainee and EMR. Now I have
less time to get to know and personally connect with each patient. Now there is
less time to discuss medicine with my trainees.
For new
doctors, I wonder if it’s more important to spend a few extra minutes to
discuss how to manage a COPD exacerbation in the outpatient setting, than it is
to teach how to multi-click and renew 14 medicines using “E-scribe”. With this
whole new domain to teach, given the same time constraints, I’ve had to bring
home work quite often, which is begrudgingly easier now with an electronic
record.
Despite
these difficulties, I continue to love my role as a medical educator. The day
to day issues are minuscule compared to the greater problems in
medicine and society. I continue to stay motivated by the idea that my tutelage
in medicine and how it interfaces with modern technology will prepare them for
a future that will need doctors that are comfortable and successful in the both
the real and digital realms.
