Jacqueline Redmer works as a family medicine physician in rural WI.
Although the use of the electronic health record (EHR) facilitates many aspects of patient care and is an important tool in clinical research, many would argue that this technology has had an oversized influence on healthcare delivery. Understandably, the thought processes clinicians use when collecting data to be entered into a structured electronic database are different from what occurs when they listen to a patient’s story and then construct a narrative based on these complaints. The use of templates for clinician documentation diminishes the importance of the patient narrative and often changes the information collected during an interview. Increasingly, many providers find they are asking questions to fill the empty data points in the EHR instead of trying to understand the person and the complexity of the illness sitting in front of them. It is my belief that this is causing a profound and unintended cultural shift within the practice of medicine.
My poem “Overdue Epic Health Maintenance” (Intima, Spring 2022) reflects on the lost patient narrative in the era of “EHR-centered” healthcare. Reading beyond a list of health guidelines, we can see a second narrative exists for this patient. As a family medicine physician, I am often faced with the absurdity of using EHR metrics to define health. Assessment of my clinical competence, the quality of the care I provide, and even my pay are linked to these EHR metrics. Day after day, I review my patients’ overdue health maintenance lists while they tell me their lives are unraveling—stories of loss, trauma, financial hardship and addiction. Instead of having the space to discuss how these issues are impacting their health, I am tasked with finding a way to transition to the heart of the visit: “Let’s get you up to date on your recommended preventive health screenings.”
In “The Quixotic Pursuit of Quality” (Intima, Fall 2015), physician author Dean Schillinger reflects on our ability to enhance care by setting benchmarks, developing guidelines, and reducing clinical variation. Although many “quality” measures are well-intended to increase accountability across healthcare organizations, their ability to make meaningful change on the disease-oriented outcomes of patients or improve their overall health is limited. In this essay, Schillinger describes the frustration he feels when working with a beloved, poorly controlled diabetic patient, Mr. Q. Despite all of his knowledge about diabetes management and systems-based change, he struggles to help his patient see the importance of better diabetes control. “Did I fail him by projecting my own needs rather than learning how best to respond to his? If so, does the predominant view of ‘quality’ engender just such cycles of physician inadequacy?”
At the expense of my EHR “performance” and efficiency, I sometimes find myself musing such topics throughout the workday. Who is this patient and why are they here? What really matters to this person at this point in their life? What if the healthcare system helped patients connect with the meaning and purpose of their lives instead of directing them towards our own disease-oriented goals? According to a 2019 study published in JAMA, they might actually live longer.
Jacqueline Redmer works as a family medicine physician in rural WI. She started writing poetry during the COVID pandemic. Redmer is currently enrolled in the Columbia Narrative Medicine CPA program.