Wednesday, 25 April 2018

Weapons of mass distraction in the National Health System

Salvador Casado

When we go to a health professional's office there are recurring constants, white coats, stretchers, blood pressure monitors and a computer on the table. The medical record is no longer a folder full of paperwork, but an electronic form on which health professionals work. There is no doubt that it has many advantages over the previous format but it has not yet been able to correct its major flaw: its great power of distraction of the professional who uses it.

The limitations of design and usability mean that at each clinical meeting a considerable amount of time has to be devoted to registering, filling in numerous protocols and making requests for analyses, consultations to other professionals or issuing prescription, bureaucracy  or reports of any kind.  The perception of many patients is that health professionals look at their screens more than they do at themselves, and that's usually not cool.  Nor is it a dish  for nurses and doctors who see how their limited time is spent on tasks that prevent them from devoting dignified attention to the people they attend.

At a time when speed and efficiency are becoming more and more important, it is also becoming increasingly difficult to listen properly. This is a multilevel  challenge, in the world of health care, even more as it is necessary to try to translate the symptoms and signs presented by the patient into accurate diagnoses and appropriate treatments. If listening is not correct when taking a medical history and performing a physical examination it will be impossible to understand what is happening to the patient and to propose appropriate courses of action.  This is sadly evident in the pediatric care  with children who consume more and more antibiotics and medicines and in the elderly who, suffering from loneliness and hopelessness,  every time they come to the health system for help they are burdened with more diagnostic labels and pills that solve them little. In general, we sink into overdiagnosis and overtreatment, the health system is becoming increasingly used as a sink for many situations of difficulty and suffering derived from ordinary life, which in the strict sense should not be labelled as illness as it ends up being.

On the other hand, the fashion of biometrics encourages citizens to use applications and devices that record their steps, heart rate, blood pressure and other constants. This calms anxiety with a certain sense of control over the body and one's own health, which is nothing more than a mirage. Measurement does not transform habits of life on its own. We end up distracted and everything stays the same.

One of the main courses of action of medicine of all time is to wait and see. Most minor situations end up resolving spontaneously in a few days without the need to apply any external remedies. However, it is becoming increasingly difficult to appeal to this possibility in the face of the demands of modern life for speed and efficiency. "Give me something to get rid of this cold now", "I need an urgent remedy to get rid of this discomfort", "I started with this symptom a few hours ago and came to the doctor for a quick solution"...

If the professional who receives us is overloaded, has little time to devote to us, or works with an information system that requires a great deal of attention and concentration, the result is that the quality and quantity of listening that can be devoted to us will be questionable at least.

If we add to this the fact that this professional does not know us because we are in an emergency department or in a hospital or primary care clinic where we go for the first time, we will have the perfect storm to leave the office with more diagnostic tests or treatments tan necessary and probably  less quality hearing from the health profesional.

At present, the quality of the listening that professionals provide to their patients is not evaluated, in spite of being one of the most valuable resources of the entire health system. Instead of protecting this input, it is sad to see how from the political and management spheres are increasingly contaminating it with infinite distractions in the form of new protocols, screens, clicks and other registration and bureaucratic demands.

In several regional health systems the computer system requires 40 to 60 seconds to authorize the signing of prescriptions.... They are not isolated cases, the punishment and hardship to which professionals are subjected ends up resenting a quality of care that is increasingly compromised by cuts, harmful health policies and other threats.

We are therefore trapped in a complex situation that does not allow for easy alternatives as it is not possible to stop using the computer completely in consultation. Awareness of the enemies of good clinical listening is perhaps a first step in rethinking the management of distractions targeting information and recording systems as leadings roles.


1 comment:

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