Jim Bradley, M.D. Sounds Off: EMRs Violating Sanctity of Physician-Patient Relationship
by Elizabeth Hofheinz, M.P.H., M.Ed., October 10, 2019
Hippocrates probably didn’t have to contend with an EMR. In fact, being old-fashioned, he probably actually touched his patients.
And that last part—the personal touch—says Jim Bradley, M.D., president of the American Orthopaedic Society for Sports Medicine, is what we are losing. “EMR systems are burying us. We can hardly spare a few seconds to look at patients and more and more we are hearing that they miss having a personal interaction with their physicians.”
Not to mention that staring at a screen all day might be detrimental to a surgeon’s eyesight. “Orthopaedic surgeons rely on sight to make critical decisions during a procedure. Too much screen time can certainly have a negative effect on our vision over time.”
If eyes are the windows to the soul, then physicians are missing a valuable opportunity to connect with their patients when they maintain eye contact. “Rather than looking a patient directly in the eye, I have to go through pages of documentation, clicking each box, etc. And the system won’t let you go from one page to another unless you have clicked all the boxes. With all of this, I don’t have time to actually put my hand on somebody’s shoulder and tell them that I am going to take care of them.”
But he does. “My nurses or physician assistant completes these for me so that I can be present with the patients. When I work with professional athletes, I use an app to dictate my notes directly…then someone from the team transmits the information into the EMR.”
“Those with the EMR decision making power are not physicians and are thus not in ‘the trenches,’ says Dr. Bradley. They have no idea of how busy we are. For example, the difference between working with a college athlete and a professional is five phone calls (parents, trainers, agents, etc.). We don’t need busywork. And yet we are required to complete pages of information that is not relevant to orthopedics. As a specialist, we should not be required to obtain and review items such as vitals and family history every visit to satisfy ‘meaningful use’ as required by Medicare guidelines. This is redundant and inefficient especially since any surgical patient is required to return to the primary care physician for medical clearance prior to surgery. ‘Meaningful use’ can be much more comprehensive and accurate when attained by the primary care provider.”
But Jim Bradley has an idea. “I propose that there be specific EMRs for each specialty. And within the orthopedic EMR there would be one for knee, shoulder, etc. This would go a long way towards saving large swaths of time that we could use to care for patients. But big universities don’t want this kind of EMR because they want a system that goes across all fields.”
“I cannot tell you how many patients have come to me for a second opinion and said, ‘Doc, the other doctor didn’t examine me!’ More and more physicians are just looking at MRIs and medical records, i.e., are essentially bogged down with clerical work. I tell all of my residents two things: 1) Sit below the patient so that they are the center of attention, and 2) Always examine the patient, regardless if you have seen them before. Such behavior helps you gain their trust, meaning that they are much more likely to listen to your recommendations.”
Dr. Bradley: “Mark my words…EMRs will drive many surgeons into early retirement.”
