Physicians As Data Entry Clerks?

Brent Gendleman (president and CE of a software consulting and development company) has written a spirited, apparently self serving, and uninformative letter to the editor of the NY Times (02/09/09 p. A20) supporting electronic medical records. A notch up is Richard's Rockefeller's letter in which he worries about indecipherable handwriting and articulates something that physicians know: "Competing insurers will always find ways to discover patients' health problems and exclude them from coverage." A.G. Krohn, a doctor, writes that office visit documentation time exceeds time examining patients. John J. Frey III (professor of family medicine) demands interoperability rather than Babel. Matthew D. Heller (rheumatology physician) observes that electronic systems spew out useless boiler plate. And Mark Merritt (president and CE of the Pharmaceutical Care Management Association) worries about the risk of a privacy proposal exposing users of electronic records to litigation and red tape.

My observation is that some physicians (perhaps they are "shy") spend more visit time looking at the monitor and interacting with a computer system that they do speaking with and actually examining a patient. You can't find breast or thyroid cancer, or hear a carotid bruit, or pick-up on a patient's depression, when your focus is having an electronic record which meets bureaucrats' needs rather than spending the time talking with and examining your patient.

My practice was, at the end of an office visit, to take about 90 seconds to dictate (for transcription) a complete record of the visit in front of the patient (often in the presence of the person accompanying the patient). This provided all of the information (history, physical, lab, diagnosis and plan) I had in a legible format, gave the patient a chance to hear what I thought, make comments to me or correct my mistakes, and promoted a trusting relationship in which the patient had all relevant information when he or she left. Years later, physicians tell me that those complete paper records contain the details that their computerized systems lack. Today's sophisticated computer voice recognition systems could readily provide hard copy from dictated records and if demanded by the bureaucrats, an electronic accessible record.

Is the use of highly educated and skilled physicians as data entry clerks sensible?