The era of laptop medicine is now upon us. Make that, laptop-computer medicine. Visit your physician and odds are that he will enter the examining room with his shiny new lap top in hand. The push for electronic records in the name of medical record portability and efficient record keeping is documented in the press.
As a physician myself, a medically necessary visit to another physician, is always a bit of a worrisome event. Decades of practice have validated the notion that physicians can, and do make errors. However, on this visit my attention became focused on the central role that the laptop computer had assumed.
My answers to a few questions were inputted to the laptop via a stylus touch pad. No typing skills for the keyboard challenged necessary. One can only hope that the pre-programmed list of choices accurately reflected my responses. Chest discomfort? Would that be on exertion? How much exertion? Was that discomfort actually rib cage discomfort as in a pesky costochondral rib joint and not heart related? Some shortness of breath? Would that be because of a low hemoglobin level, or in keeping with the activity at the time? Did the touch pad include all these diagnostic possibilities? My physician, examining-hands-off -interview, ended with the recommendation for a specific invasive, medical, diagnostic procedure. I have decided to wait. Was this what the lap top computer decided upon?
It is easy for me to visualize how this new era of computerized record taking might well fit into the more efficient model of care envisioned by Dr. Donald Berwick, President Obama’s recess appointment as Head of the Center for Medicare and Medical Services. By edict, there would be a universal medical history computer program. Physicians would enter all information via a touch pad, selecting from the pre-programmed choices. No room for individualized side comments or observations. Once entered, the choices would trigger a diagnosis based on pre-programmed , best fit, algorithms. Once the computer has made the diagnosis, the treatment plan would be offered from the “best-evidence based” program. Much like the software licensing agreements common on our computers, the computer might offer the physician to click on “yes” that he agrees with the treatment plan. If he clicks “no”, he would be informed that he would be personally responsible for failure of his alternate diagnosis/treatment. A centralized computer system would monitor patient and physician compliance. The number of minutes spent by the physician for each patient would be recorded by this same central computer, compared to the established standard, and be used to rank his performance, and establish his payment. Both patient and physician would be able to contact an off-shore-based, complaint resolution center to dispute the computer decisions.
The next Berwickian cost saving step would be to have the patient fill out his own yes-no questionnaire, and dispense with the physician interview.
Welcome to the possible future.
Charles G. Battig, M.D.