A doctor I used to work with once told me that “80% of diagnosis is history”--the individual stories the patients tell you about what has compelled them to come to your office. Sometimes patients will provide you very detailed, almost hourly chronological compilations of the preceding few hours or days in their lives; more often the history will be only slightly better than a vague, more of an “I-just-feel-yucky” overview that doesn’t tell the doctor much of anything, and the doctor then has to tease information out in bits and pieces and sometimes mumbles and grimaces and “my-balls-are-on-fire” (that’s an actual quote from a patient when I was working as a registration clerk in an ER in the 1980s) verbal ejaculations.
A doctor may not be able to glean much from your current vital signs, for instance: Your current temperature or blood pressure may be perfectly normal; what might matter is, say, that you’ve not been feeling well and so you’ve been checking your own temperature or blood pressure or blood glucose over the last three days and it has been wildly fluctuating, or running higher or lower than normal for no apparent reason.
Details count, even the vague or fuzzy ones--or maybe especially the vague or fuzzy ones.
Got to thinking about this tonight when my incoming work flow mysteriously dried up, I had time on my hands, and I started trying to research the potential/probable impact of the big push toward electronic health records on my own livelihood as a medical transcriptionist.
Frankly, it looks pretty grim from here.
Funny, or perhaps paradoxical, thing about the medical industry, from what I’ve seen over the past couple of decades is an understandable (on one level) desire to eliminate as much of the “human element” as possible--humans make mistakes, after all. Reducing as many aspects as possible to the least common denominator, that is, trying to “idiot proof” them, makes sense in some ways. The more that can be automated, the better and more efficient and less costly and less prone to error the whole system can be.
Right?
But it’s one thing to take the “human element” out of, say, the checkout process at your local Wal-Mart by installing “self-checkout” aisles. The human element removed from that process, of course, is the job of a human cashier (and in effect turns us all into unpaid employees of the retailer, not coincidentally); the corporation cuts its expenses, but the process is no more efficient and no less prone to error, and the corporation gets a lot of free labor. The fact is, though, a customer can drag a box of cereal across a scanner just as well, if not as quickly, as a trained cashier can.
Health care is different, though: It is founded on human-to-human interaction between a patient and a provider.
“History is 80% of diagnosis.” The individual’s story is what drives the provider’s treatment plan more than any other single factor. It is the history that cues the provider to order certain tests, etc., that essentially sets the provider off on one particular course versus another.
It would be difficult, I think, to reduce history-taking to a series of drop-down menus on a computer screen or “palm pilot,” etc.
I haven’t worked in a hospital for a while, but the way things used to work was that a doctor (or nurse practitioner or other provider) would come in, take your history and examine you without so much as a notepad between them and the patient. They might or might not chart their findings right there; where I worked, they did most of their charting in a conference room or in their offices. They wanted to provide the patient at least the illusion of “undivided attention.” Eye contact mattered, and they couldn’t make eye contact if they were scribbling notes in a chart. Plus, and I really am only surmising this based on what I used to do when taking telephone “histories” from patients--that is, took voluminous notes--it forced them, the providers, to instantly separate wheat from chaff, pick out and remember the salient facts from a sometimes rambling or sometimes skeletal story told by a patient. I HAD to take voluminous notes, write down everything someone told me over the phone, because I wasn’t qualified to judge what was important and what wasn’t (although I did get better at it over time, and with a lot of practice).
From what I understand, which may not be much, with electronic health/medical records, providers will have to enter information in a computerized record even as they interview the patient.
So much for eye contact.
I don’t know how all this will evolve; nor, I think, does anyone else, really, although many take stabs at speculation. Probably it means the end of my job at some point, and then maybe rebirth of it when the powers-that-be (the financial PTB, that is), realize that health care is one of those things from which the human element truly cannot be removed, entirely, no matter how “cost-effective” that dream might be.
In the meantime, I’ll be exploring other career options. (Actually dark blue is a good color for me; I would probably look great in one of those vests with “May I Help You?” stenciled across the back.) And I’m really too old for this.
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