Stories are the backbone of who we are. They provide context, insight, subtle and not-so-subtle hints about ourselves and those around us. They teach us lessons and help us determine similarities and differences so that we can avoid mistakes and replicate success.
I recently listened to the popular Serial podcast. For those who are unfamiliar with the show, it is dedicated to deeply exploring different narratives, stories, and evidence, in order to find insight into a mystery. I found it fascinating for myriad reasons, but mostly for the way it was told. And, at the beginning of each episode is the reminder: “This is Serial: one story told week by week.”
It’s engaging and thought-provoking, but what I like most is that it forces the listener to consider the same principle case from different perspectives. I was struck by how similar this journalistic process of poring over reports and talking with people to hear their perspectives is to the art of medicine. When a patient comes to see you with a set of symptoms, you have your checklist: you examine him, you ask questions, maybe order lab tests.
If your patient’s condition persists, you might talk to his son, who brought him into the follow-up appointment, and he might mention something his father had forgotten or dismissed as irrelevant. You carefully listen to what is said, and what is not said, noting anything that is out of the ordinary. You use that patient’s chart as your journalist’s notepad.
The difference is that physicians don’t always have the luxury of time. Whether it’s because treatment decisions need to be made or there is a line of patients waiting to be seen, they need to have quick access to the most relevant data and best practices so they can make informed decisions and recommendations to their patients. They need to be able to collaborate with a specialist to look at a medical image and report together, discussing whether that secondary finding is something more than it appears.
Compounding matters is that as the healthcare industry awkwardly shifts to value-based care, physicians have been forced to precariously straddle the line between two oppositional models, and amidst it all, they try desperately to not let the tumult affect their patients. They’re beholden to the regulatory bodies that govern how they practice and they have sworn an oath to protect and care for those who have entrusted them with one of their most valuable gifts: their health.
As Drs. Patrick Ober and William Applegate so eloquently as succinctly articulated in their recent article “The electronic health record: Are we the tools of our tools?”: “Attentiveness to the nuances of communication is an essential attribute of a skilled physician; in its quest for medical standardization, the EHR discourages nuances and promotes functional medical illiteracy.”
Physicians are being forced to make hard choices, and one of these sacrifices often comes at the expense of the patient story.
Physicians are being forced to make hard choices, and one of these sacrifices often comes at the expense of the patient story. And when you lose that story, the patient becomes a collection of somewhat unconnected data points. This has a profound downstream impact as the next attending physician will have to go through the same rigorous exercise of asking questions and sleuthing around, which not only frustrates the patient, it can lead to unnecessary wasted time.
The overall health IT endgame is the right one: creating a continuous and integrated care cycle that helps drive the best care outcomes. While technology is a key component in the healthcare ecosystem, it should only play a supporting role. It helps sifts through the massive amounts of data and appeases the regulatory requirements so that the physician can listen attentively to his patient as she walks him through the series of changes and symptoms she has experienced.
In healthcare, the story is everything. Nothing happens in a vacuum. As physicians, it is our responsibility to listen to our patients and their family members, noting the details, and helping them understand and treat their symptoms. We can’t do this if we’re not paying attention.
Dr. Nick van Terheyden is the CMIO at Nuance Communications where his insider perspective allows him to put his medical and technology expertise to work for clients who are striving to raise the bar for healthcare delivery paying attention not just to processes and systems, but to people. Follow him on Twitter.