Letters to the Editor  |   May 2009
Electronic Health Records—at What Cost to Care?
Author Affiliations
  • Daniel H. Belsky, DO, MSc
    Longport, NJ
Article Information
Professional Issues
Letters to the Editor   |   May 2009
Electronic Health Records—at What Cost to Care?
The Journal of the American Osteopathic Association, May 2009, Vol. 109, 255-256. doi:10.7556/jaoa.2009.109.5.255
The Journal of the American Osteopathic Association, May 2009, Vol. 109, 255-256. doi:10.7556/jaoa.2009.109.5.255
To the Editor:  
I was recently a patient at a leading teaching hospital in Philadelphia, Pa, where I underwent neurosurgery. Before my hospitalization, I was subjected to preadmission testing, which included a medical history and physical examination, electrocardiogram, chest radiograph, and laboratory tests. All of these procedures were conveniently conducted during a single visit to a freestanding facility adjacent to the hospital. However, I found the history and physical examination sorely lacking in thoroughness. 
When I was in osteopathic medical school, my fellow students and I had an excellent course in the taking of a patient's complete medical history and in the competent performance of a thorough physical examination. I was taught that in a properly taken history, the physician introduces him- or herself to the patient and engages the patient in discussion, helping to establish rapport and promote the bonding process between patient and physician. This discussion could also help guide the physician in establishing a working diagnosis even before the physical examination is conducted. I always incorporated these tenets into my practice as an osteopathic physician. 
When I was undergoing these preadmission tests, the history taking consisted of a checklist of diseases for me to complete—independent of any personal interaction with a physician. The checklist also included blank spaces for me to list any drug allergies, previous surgeries, medical conditions, and current medications. After I completed this form, a nurse practitioner dutifully entered all the information into a computer. My attending surgeon played absolutely no role in this history-taking process. (I had filled out a similar history form at my initial visit to the surgeon's office.) 
My physical examination, which was conducted by the same nurse practitioner, was a further extension of the impersonal electronic age of medicine. As in the history taking, all information that she obtained during the examination was entered into a computer. The actual examination that she performed was a joke. Several major body systems were completely ignored. Blood pressure was taken, but heart and breath sounds were auscultated through two layers of clothing, thereby eliciting excessive friction to the examiner's ears. The midabdomen was quickly palpated, but there were no examinations of the upper or lower abdomen. Did I have an enlarged liver, an inguinal hernia, point tenderness? There was no way to tell from this examination. 
The examiner never checked my ears, nose, or throat. Nor did she perform even a cursory neurologic examination, such as checking my reflexes or checking my eyes for reaction to light or to the “follow my finger” test of ocular motility—despite the fact that I was being admitted for neurosurgery. 
My thyroid gland was not palpated, and there were no checks for cervical or supraclavicular lymphadenopathy. Furthermore, my upper and lower extremities were ignored, with no checks for cyanosis of the nail beds or for dependent edema. My back was totally nonexistent to the examiner. 
The nurse practitioner who took my medical history and conducted my physical examination spent about 45 minutes with me. She was entering data into the computer for approximately 35 minutes of that time, leaving only 10 minutes for any personal interaction. 
Is this the future of medicine? Must personal interaction between patient and healthcare provider be so severely curtailed? Is storing relevant information into a computer database so paramount to patient care? 
I agree that electronic storage of information improves the maintenance and availability of patients' medical records and helps prevent errors by physicians and other hospital staff. A universal retrieval system for such records is certainly part of the future of medicine. However, I also believe that we should not abandon the time-tested model of the personal patient-physician relationship, which served us so well for so many years. 
Perhaps it is time for the American Osteopathic Association to establish a task force to study this issue.