May 20, 2009
Why Are Doctors Such Luddites?
Information Technology Is Hard For Older Members Of The Profession To Incorporate Into Their Daily Routines
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(AP / CBS)
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Section Tech News All about the digital world, from computers and gadgets to industry news and hot tech trends.
But there's a difference: Feinerman is a Lasik eye surgeon.
"All the people working in our office are doing it, anyway, and I said, 'Why not also do it for patients?'" Feinerman said.
Feinerman's tweeting obviously is a rarity for those in his profession. More than a decade after the Internet went mainstream, only an estimated 17 percent of physicians have electronic health record systems.
The big trade associations representing the medical establishment, such as the American Medical Association and the Medical Group Management Association, can't estimate how many of their members use the microblogging service, or for that matter, how many of them deploy consumer-facing technologies in their daily interactions with patients. But if anecdotal evidence is a fair barometer, assume the following: Doctors who grew up in an earlier era are likely to cling to their notepads and pens until the day they retire their stethoscopes. For their younger colleagues, by contrast, consumer technology is just another way to connect with patients.
In its Orange County, Calif., offices, the Feinerman Vision Center staff has set up a Mac notebook in the waiting room with a private Twitter account. As an eye operation concludes, updates go out that enable a patient's friends and family to read how the procedure has gone.
"It's just a different way to do outreach," Feinerman said.
So why aren't more doctors early adopters of services like Twitter? As soon as a new MRI machine or microscope comes out, they tend to be all over it. But practitioners say information technology is hard for older members of the profession to incorporate into their daily routines.
In part, that may be because there are few applications in health care that actually delight doctors. There are still no medical equivalents to Apple's iTunes or iPhone. And like the rest of us, doctors are creatures of habit. But change is happening. With each graduating class of doctors, more physicians feel comfortable with technology.
A survey published in December by Vanderbilt University Medical Center hinted at this trend, though from a different perspective. The survey focused on doctors, mostly on the younger side of the spectrum, trained in IT-rich environments. Of the doctors who wound up working at offices with more rudimentary systems, the vast majority expressed unease about their ability to offer proper care to patients.
A medical generation gap, if you will, is coming into fuller view. In fact, it's something I first saw a few years ago, when I was rushed to the hospital after a hard fall that cracked my head open.
Upon my arrival at the emergency room, the thirtysomething physician who attended to me took notes on a tablet computer. He could then transfer the data from the consultation to a central server over a wireless network. (He also had a high-end smartphone hanging from his belt, just in case.)
As a technology reporter, all this intrigued me more than learning what was going on with my badly smacked noggin.
The doctor told me that age--usually the 40th birthday--often defines a physician's predisposition toward incorporating high tech into his or her daily interactions with patients.
A few hours later, I was in the recovery room when another ward doctor approached me. As he took out a pen to scribble into a notebook binder, I just had to ask.
"You don't like tablet computers?"
He gave me a hard look and mumbled something about how it wasn't his cup of tea. I'd say he was at least in his mid-50s. That was all I needed to know.
"If you don't use tech, per se, in your daily life, at all levels, and you're not comfortable with it, then it's unlikely that you're going to be as speedy (to embrace) technology," noted Dr. Todd Rothenhaus, senior vice president and chief information officer of Caritas Christi Health Care, the second-largest provider in Massachusetts. "If you're not a touch typist...or if you never use a mouse or are accustomed to using a PC as part of your daily activity, then there's going to be an enormous barrier."
Rothenhaus may be right. The hope within the Obama administration is that many of those barriers will crumble in the aftermath of the passage of the $787 billion economic-stimulus package, which includes $19 billion for health information technology and another $10 billion for the National Institutes of Health.
Clearly, the U.S. population is behind a concerted effort to digitize medical records, according to a recent poll (PDF) conducted by NPR, the Kaiser Family Foundation, and the Harvard School of Public Health:
"Fully three in four say it is important for their health care providers to use electronic medical records (EMR). A large proportion of the public also sees benefits to nationwide adoption of this technology. Majorities say that if the United States adopted greater use of an EMR system, their own doctors would do a better job coordinating their care (72 percent say this is at least somewhat likely), that the overall quality of care in the country would be improved (67 percent), and that fewer people would get unnecessary medical care (58 percent.) Just over half (53 percent) say there would be fewer medical errors."
In theory, that sounds like a slam dunk. But life usually turns out to be a bit more complicated. Consider the experience of James Dom Dera. An assistant professor of family medicine at Northeastern Ohio Universities Colleges of Medicine and Pharmacy, his practice made the decision to become a "paperless office" two years ago. However, the transition to electronic records proved more difficult than he envisioned.
Dom Dera, who was accustomed to quickly jotting down notes taken during patient visits and flipping through papers, says that only in the past year has he gotten his typing groove back.
"I'm actually starting to see the benefits of a class I took in high school: typing," said Dom Dera, who, at 37, is relatively young. "I've gotten pretty good at typing and clicking while still maintaining eye contact. At the same time, I'm cognizant that sometimes it's more appropriate for me to stop typing, close my laptop, and just listen. I guess that's the art versus the science of medicine."
Dom Dera and his colleagues, including the nursing staff, now use tablet PCs connected to a wireless network. Nothing is stored locally, and the data gets transmitted in real time without the need for a Save button, he said.
That doesn't sound anything like my doctor; he's terrific but definitely old-school. Getting back up to speed when it comes to using a keyboard only hints at the challenges older physicians face in trying to adapt to a world in which new technologies regularly proliferate throughout the larger society.
"That's exactly it," said Lasik surgeon Feinerman, who is 42. "I grew up in the computer age. This is just my generation. I still feel old when I come to the office, and most of the staff is in (its) 20s and 30s. But I'm trying to use tech and have a proactive attitude to make our practice fun and keep people in touch."
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Add a Comment See all 17 Comments
- Is Luddite a fancy word for Arsewhole? Because all the doctors I've seen are just that.
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- Older doctors have still have the "God" complex that plague so many doctors....it's a shame .
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- my doc's office has been computerized for years. i've found that i don't really care for it because none of the practioners really seem to listen to their patients. they ask questions and click boxes, and few rarely even touch me, unless it's to listen to my lungs. i've been to the doc three times for the same problem, and now, i'm being sent to a specialist, but my doc still hasn't answered by questions. he's just clicking away on a computer. i'll be looking for a new doc soon.
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- Whoa, whoa. There's a difference between refusing to use a computer at all and not using Twitter. Twitter is just popular nonsense, who's only purpose is to use us to make its creators filthy rich.
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- First let me say I'm not enthused about computerized medical records due to privacy concerns. We cannot protect credit card information, secret plan plans, social security numbers and much more private information. Hackers are going to have a field day with medical records. Also who is going to have access.
Secondly I have seen two doctors this week , a female rheumatologist and a male GP who both face the computer with back toward me asking questions. Rheumatologist did slight physical assessment later but GP just sent my prescription via computer to pharmacist and did not physically check my problem. Why not just do visit via email or webcam and charge accordingly. They could save on office help - Reply to this comment
- Any physicians avoiding the use of our modern technological methods of communication and record-keeping are denying their patients benefits of the Information Age in the diagnosis and cure of their condition or disease. -- Most of the really useful medical research being done currently is available on the web, and doctors who do not use it cannot access the information needed to help their patients, in a timely manner. -- Those doctors should not be allowed to practice medicine, much as a blind person should not be allowed to drive. -- It does not make any sense at all.
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- Converting an entire profession to computerized technology isn't as easy as it looks. First, we need to remember that one of the main problems that caused errors in the present system is the handwriting skills of physicians--or rather the lack of them. And just in case you thought that getting a doctor to dictate his medical procedures into a Dictaphone or similar gizmo might improve the situation, guess what? His speech is about as good as his penmanship.
And what of errors that used to be local? Now, they're nationwide. The system might assign each patient in a hospital or under a certain doctor's care with an ID number. But just transpose a digit or two and watch everything go haywire while someone has to use guesswork to figure out just whose records they have.
Imagine that when you enter an emergency room there are perhaps half a dozen corporate entities that want a piece of you--or your wallet. You will be billed by each of these entities and sometimes through a local collection agency. And you know that those guys have no bedside manner to speak of.
Then there's the issue of control. An electronic system is going to have a head end--and someone is going to control it. The government wants that job. And they'll use all that data to decide what treatment you'll get, by whom, and even IF you will be treated at all. Gone will be the old fashioned conferences between a patient and his or her physician. Now the government will be eavesdropping.
If you want a preview of what our health care system will look like when these guys get through monkeying with it, just take a look at Great Britain, or Canada. The Canadians come down here for emergency care because they can't get it at home. And we want to be just like them???>? - Reply to this comment
- This article and some of the comments seem to display a total lack of understanding of the incorporation issues surrounding the adoption of electronic medical records into the variety of clinical practices. Most people I talk to like to talk to their doctor and not the back of his head as he relates more to the computer than to them. Much that has been an intangible value in the patient-doctor relationship (at least when it is a productive relationship which it is not always!) will be lost as the proportion of time a doctor spends dealing with a human being decreases as the demand to "look good on paper" increases. The profession will decline to a level of an overpaid data-entry tradesman...and we will not even know what we have lost.
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- Purveyors of computer technology dwell on its benefits, but conveniently forget about all of its problems and negatives. Practical (improved throughput), affordable and secure need to be in the equation. Maybe the old doctors are not as stupid as you think, but rather wise.
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- ["Fully three in four say it is important for their health care providers to use electronic medical records (EMR). A large proportion of the public also sees benefits to nationwide adoption of this technology. Majorities say that if the United States adopted greater use of an EMR system, their own doctors would do a better job coordinating their care (72 percent say this is at least somewhat likely), that the overall quality of care in the country would be improved (67 percent), and that fewer people would get unnecessary medical care (58 percent.) Just over half (53 percent) say there would be fewer medical errors." ]
here in lies the problem with polling. all of what is listed above is based on absolutely nothing at all. even if five in five said it would be better ... what do they know?
technology is not the cure to all our ills ... in fact ... it the end it will be the major contributor of the death of us all.
all this bluster about using technology is just another ploy to have monies be spent on it ... today claiming that it will solve all these problems ... and next year they'll be telling you how what you have is inferior ... and you need to upgrade. it's a constant change cycle ... whithin which you will be trapped forever. the technology biz has been doing this for years. - Reply to this comment
- Maybe it is because after the nice cars, nice mansion, paying for their kids private school, country club memberships, 401Kcontributions, and their spouses allowance, they don't have much leftover. Must be tough being a doctor!
Posted by endrepubs at 11:46 AM : May 20, 2009
You forgot their $100,000+ debts coming out of medical school, the miniscule pay they make during long years of training, as well as the responsibility that comes with the job (unlike say a member of the UAW). And, no, I'm not an M.D. - Reply to this comment
- So big deal, not all doctors do twitter, or any of the other inane conveyances for transmitting mostly inane bits of worthless blather to others who are in awe at what the digits can do. If doctor's weren't into keeping up with technology, their science would never advance and neither would they. At least their technology calls for real intelligence and not the artificial kind. Consider the advances made in robotics and how that's being used for surgical procedures.
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- Gosh,,,,,,,,,, I don't think being a Luddite is such a bad thing. In fact, I think it's under rated.
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- Older Doctors have always had a tougher time staying up with advances. New technology in medical treatments and equipment are out of their scope of understanding. The older the Doctor, the less inclined they are to accept the changes. This tends to be true for most older people where technology is concerned.
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- My primary care medical provider, a female MD in her forties, uses a variety of technology. No Luddites here.
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- Actually, to become an MD, a doctor has to develop an incredibly keen sense of memory. And as he develops that, so too he develops his own internal, mental "filing system." I suspect that the prospects of turning that over to a machine must be a little frightening.
I've noticed that younger doctors who use the technology while getting through medical school don't seem to have the same reluctance. - Reply to this comment
- Doctors are such luddites because they are such cheapskates. Believe me, I have had experience with doctors and their spending and most are very cheap about spending their money. Maybe it is because after the nice cars, nice mansion, paying for their kids private school, country club memberships, 401Kcontributions, and their spouses allowance, they don't have much leftover. Must be tough being a doctor!
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