How 3 surgeons connect with patients in a tech-driven world

Anuja Vaidya -   Print  |

Three spine surgeons discuss how they make sure their relationships with patients do not suffer due to the increase in health IT use.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: What are the key non-clinical skills every spine surgeon needs to have?

Please send responses to Anuja Vaidya at by Wednesday, May 15, 5 p.m. CST.

Question: How can spine surgeons ensure health IT tools do not get in the way of the physician-patient relationship?

Mark M. Mikhael, MD. Spine Surgeon at NorthShore Orthopaedic & Spine Institute and Illinois Bone & Joint Institute (Chicago & Glenview, Ill.): Spine surgeons need to remind themselves of interpersonal skills as they input information during clinic visits. With an increase in screen time, surgeons should be sure to look at patients as you're listening to them. Take time to make eye contact during the exam and as you're addressing patient modalities.

For administrative time-savers in our increasingly tech-dependent world, surgeons can use voice-to-text for dictation and employ tablets for patients so they can input information themselves during down time. Making these small changes should allow more quality time together [with patients] and strengthen the physician-patient relationship.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Thanks to the prevalence on work-intensive EMR charts, this is a daunting task. I act like a scribe for the patient. I don't say much for the first half of a visit. I concentrate on what brings them to the office. I maintain eye contact and engage, sometimes repeating back what they just said. Or, I will reinterpret it back to them for clarity purposes. Eye contact, I find is the easiest way to keep that going.

The EMR is not the great hope as it was touted to us a decade ago. As physicians, you have to resist the urge to close off and allow the software to widen the gap. If you find your EMR pulls you too far away from them, maybe it's time for a new program. Some people hire scribes, but I feel that is an unnecessary, and frankly, silly way of spending valuable resources. Examining the patient is also a way to get back to the roots of what we do, back when doctors visited patients in their parlors and brought with them that iconic little black bag.

Issada Thongtrangan, MD. Orthopedic Spine and Neurosurgeon at Minimally Invasive Spine (Phoenix): The adoption of EMRs has led to many improvements in healthcare by providing physicians access to the comprehensive medical histories of their patients. Recent evidence found that doctors who use EHRs spend nearly one-third of their time looking at the screen. This lack of focus might impede communication with the patient and interfere with patient engagement.

It is very important for me to directly engage with the patient and their family members by looking them in the eyes, listening to them and empathizing with their problems. I can easily miss nonverbal clues from them if I am looking at my computer. I want to make sure that their visits are worthwhile and that they understand their problems and the plans to get them better. I can finish my electronic notes later.

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