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‘Medical gaze,’ not ‘screen gaze,’ is essential

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A husband and wife’s  (both are physicians) separate visits to ophthalmologists shows how forcing many physicians to spend much of their time “furiously typing” electronic medical records hurts care by reducing the “presence” that physicians and their patients need together.

Christine A, Sinksy, M.D., writes:

“My husband was seen at a regional academic medical center, first by a resident, then a fellow, followed by the attending physician. With each physician, he was aware of how much they typed — furiously typed. During the first few minutes of the visit, each physician discussed the situation face to face with him, with genuine concern. Another few minutes was spent on the slit lamp exam. Then each physician shifted gears. For the remainder of their visits, each was glued to the computer screen. While they typed, the patient felt like an afterthought.”

“Each of these physicians had given up so much of their lives to master their skills … and to help people in need, and yet here they were spending so much of their time typing, furiously typing, instead of interacting with the patient. My husband wondered how many patients weren’t able to make appointments or see their doctors because so much of these physicians’ time was spent on this typing.”

My visit, on the other hand, was at the multi-specialty clinic where my husband and I have spent our careers as general internists. My attending physician did not type much at all. The nurse checked me in, asked how things were going, did standard visual tests, and measured my intraocular pressure. She returned with the physician, who talked with me face to face. While he examined me with the slit lamp, the nurse provided him technical data from my previous visits, and then he relayed to her additional technical data from his exam, which she recorded. He then … talked with me again, this time about options and next steps. He consulted previous studies in the electronic health record. But he was not furiously typing. He was talking and attentively listening.”

“In a word, my visit to ophthalmology included what Abraham Verghese has termed ‘presence.‘ The physician and nurse were present to me. And I was a human presence to them. To be fair, my husband was also a human presence to his physicians, but it entailed more strain on their part because of their assigned role in data entry. ‘Presence’ comprised a smaller portion of the overall visit.”

“Verghese makes the case that the central act of medicine is observation, and that the central tool is ‘the medical gaze.’ My husband’s visit comprised a lot of ‘screen gaze’ time. My own had more of ‘the medical gaze.”’

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