Doctors learning new ways to hear stories

Electronic medical records (EMR) are a boon to doctors. They gather all information about patients in one convenient place, easily accessed when someone presents a new set of symptoms or some variation of the old. As the patient’s story unfolds, her doctor can scroll through the appropriate records, underpinning the narrative with knowledge of previous illnesses or injuries or stresses.

Doctor and patient

Doctor and patient in City Hospital Tuberculosis Division, 1927. Item 2721, Engineering Department Photographic Negatives (Record Series 2613-07), Seattle Municipal Archives.

The problem in the U.S. is that those records have to be coded for insurers, reducing everything to medications, tests, diagnoses. The narrative becomes fractured, the interwoven story of the patient lost.

Writing in the April 22, 2010 issue of The New York Times, Dr. Pauline Chen quotes Dr. C. T. Lin, a practicing internist and chief medical information officer for the University of Colorado Hospital in Denver: “Physicians think in stories. How can you possibly point and click your way through a patient’s 10-year history?”

Speech recognition software may ease the problem, allowing physicians to dictate patient histories in a way that returns narratives to their records.

Reading the article, I reflect on the seven-minute billing blocks that have become standard practice in British Columbia health care. I value the universal system that has allowed me a long freelance career unshadowed by the threat of loss of medical insurance. But I wonder if the pressure on patients to spill their stories quickly and on doctors to diagnose in pieces doesn’t add to patients’ stress and decrease the chance of accurate diagnosis.

Wellness, as opposed to our western focus on sickness, is a matter of balance and wholeness. Our stories are essential to that. The labyrinth of American insurance requirements and the forced brevity of our B.C. patient-care system both disrupt our narratives. And if our doctors cannot really hear our stories, they can only treat our symptoms, not assist us to recover balance and wholeness.

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