Healthcare Gone Digital
A NextGen Free-Standing Perspective Article
On a typical day, Dr. Ming Shing Chiu spends half his time in the clinic, doing new patient consultations and follow-up appointments with returning patients, addressing problems ranging from irritable bowel syndrome to hepatitis. The other half of the day, Dr. Chiu can be found in the procedure room, doing colonoscopies and gastroscopies on patients, making diagnoses about abdominal pain or bleeding in patients. Dr. Chiu, a gastroenterologist who works for Kaiser Permanente, grew up and attended medical school in Taiwan before moving to the U.S. to practice medicine. After overcoming challenges like learning English, adjusting to American culture, and making a life for himself and his family in the United States, Dr. Chiu now has a new challenge: adjusting to the computerization of the healthcare system while maintaining the integrity of the physician-patient relationship.
Dr. Ming Shing Chiu
Kaiser Permanente, a major heath maintenance organization (HMO) based on the pacific coast, has begun to computerize handling of patient information and now expects its physicians to fill out patient charts electronically. Additional regulations include requiring physicians to maximize efficiency by only allotting each patient a certain amount of time per visit.
Adjusting to this new system has been difficult for Dr. Chiu so far. Part of the generation that grew up without computers, he has found it "difficult to adjust to having everything moved from paper to the computer screen. I have to learn how to pull up patient charts, as well as navigate search systems and such. After twenty-four years of writing charts out on paper and looking things up in reference books, it is a major transition."
Despite these difficulties, Dr. Chiu firmly asserts, "computerization is ultimately good for patient care. Although e-charting may create more work for the physician–especially those whose computer skills are not well-developed–it benefits patients enormously. Up until recently, it was difficult to retrieve a patient's medical history quickly, especially in the case of an emergency, since paper charting is not portable. Now, a patient's medical history can be easily pulled up on the screen by the physician, and this has vastly improved the quality of medical care patients receive, because the physician will have a better understanding of the patient's history."
In addition to changing the efficiency and accessibility of patient records, the computerization of the Kaiser healthcare system is changing how physicians interact with their patients. This, for Dr. Chiu, has been the hardest adjustment to make. "My patients are all very important to me, and it is very hard for me to sacrifice a little of the personal touch that I try to bring to my practice in order to keep up with this new system."
"In the past," Dr. Chiu said, "physician-patient relationships were built up slowly because we spent a lot of time talking to our patients." Physicians would usually devote their attention to the patient during the consultation, and fill out the patient chart after the patient had left. Now, physicians are encouraged to fill out charts on the computer as they are talking to patients, due to the increasing demand for efficiency. "Balancing good communication with the patient while filtering information to write down can be tough," admitted Dr. Chiu. "It's a little distracting, and you have to learn to be an exceptional listener in order to process and write things down while maintaining a rapport with your patient. It is especially bad for doctors like myself whose typing skills are not as developed as I would wish, because I have to divide my mind into three tasks: figuring out where the keys on the keyboard are, listening to my patient, and responding to my patient. And it's just one patient after another. I don't have much time in between patients."
Even the patient visits themselves have been cut short by this demand for higher patient output by doctors. Before the healthcare system began to be highly constrained for efficiency, physicians could devote more time to taking care of their patients–either by spending more time talking to patients during office visits, by visiting patients in the hospital, or even by making house calls. "Nowadays, due to time constraints placed upon them by management, doctors are required to be more efficient, so each patient receives an average of only fifteen minutes per visit," said Dr. Chiu.
Sadly, Dr. Chiu remarked, "It seems to me that we are losing the 'human touch' that is so vital in physician-patient relationships. The emphasis on medical documentation is becoming increasingly important due to concerns about medical-legal lawsuits, so the growing trend is that physicians spend more time documenting the conversation than caring for patients. It seems to me that the capture of information is becoming more important than showing compassion towards you patient. It's hard to show compassion when one is constantly typing as the patient is talking." And while he acknowledges that documentation for the purpose of avoiding medical-legal lawsuits is important, Dr. Chiu exhorts physicians to "to be careful to keep it from becoming the focus of being a physician."
As the role of information technology grows in the healthcare system, Dr. Chiu advises the new generation of incoming doctors to not get too caught up in this, and to "remember the importance of the physician-patient relationship."
"One of the most important aspects of being a doctor is having good communication skills with your patient. You need to be able to listen as well as talk to your patients, so you can better understand where they are coming from, what their concerns are, what cultural differences may be affecting their perceptions of their illness. But most importantly, as the healthcare system becomes increasingly like a well-oiled, efficient machine, you must remember to not get so caught up in documentation that you neglect to form a true relationship with your patient."
After all, Dr. Chiu adds, "We do not come into medicine because we enjoy documentation. We practice medicine because we are passionate about helping and healing people, and it is important, especially for the new generation of physicians in this technological age, to keep this as their focus." 
Dr. Ming Shing Chiu is a gasteroenterologist at Kaiser Permanente, an HMO based on the pacific coast.
Michelle Chiu is a writer for the Next Generation and a member of the Harvard class of 2010.