Friday, December 23, 2011

Seeing patients eye-to-eye

I ran across this interesting perspective piece in the New England Journal of Medicine, where Daniel Wolpaw, a physician at Case Western Reserve School of Medicine laments at how clinicians and trainees are often relegated to spending most of their time eye-to-eye with computer screens -- leaving less and less time for communicating with and taking care of patients [1].  Wolpaw further describes how the "bizarre geography" of rounds -- where the team often stands above the patient at a distance -- detracts from the development of a meaningful patient-provider relationship (while encouraging the relationship that providers develop with the electronic medical record).

This is just as true at our institution, where many clinicians -- physicians, pharmacists, and nurses alike -- spend most of their time tied to a computer screen. I believe much of it is unintentional -- an unfortunate reality of what our job now entails. The documentation of one's activities is certainly an important part of the patient care process; however, the litigious and heavily cost-scrutinized atmosphere of US health care has almost made this documentation more important than the actual care itself. I often hear interns and residents express their disappointment with how much of their time is spent writing notes -- history and physical notes, progress notes, communication notes, consult notes -- the list goes on and on. My day is comprised of similar activities -- verifying medication orders, writing notes in our pharmacy communication system, documenting clinical activities -- with little time for interacting with patients.

As Wolpaw's piece continues, he describes how the use of a portable stool on rounds transformed the delivery of care provided by members of his team  By sitting down and seeing patients "eye-to-eye", members of the team were able to develop (and appreciate) the meaningful and valuable relationship these close interactions afforded. 

Since reading Wolpaw's insights, I have definitely found myself paying more attention to how the team interacts with patients on rounds each morning. I have been amazed at the difference between those patients with whom one of our members is able to sit down and have a conversation versus those where we engage in the "question-and-answer mini-lecture" that Wolpaw describes in his piece.

I have also tried to incorporate the process of sitting down and having a conversation with patients during my interactions with them and their families. We recently undertook a hospital-wide initiative to offer counseling to every patient being discharged on anticoagulant therapy.  I cannot help but notice a distinct difference when I have the opportunity to sit down and have a conversation with patients rather than lecturing to them from afar.

For pharmacists, I imagine the concept of placing this distance between us and our patients has been ingrained in us as part of our training -- the idea of standing behind a counter and often a foot or more above our patients.  It all has me wondering though... how many patients would still waive the opportunity to be counseled by their pharmacist if we removed the counter and saw them eye-to-eye?

  1. Wolpaw DR. Seeing eye to eye. N Engl J Med. 2011 Dec 1;365(22):2052-3.

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