Query

Figure. Photo by: Anson Liaw

I once lived the life of a paper-based creature. I wrote notes on multicoloured things called Stickies. I had a notepad to remind me about important events and items to follow up. I carried a pen. I wrote in things called charts whenever a patient came to see me.

This life made sense to me. Paper begat paper, which begat more paper. Papers were signed, sent, filed, shredded; papers were shuffled, left on my desk, left overflowing in my in-box. Letter size, legal size, Sticky-size. Paper was my comfort and delight.

Then came the electronic revolution. Promising an end to paper, Computer People came to preach about their “record.” An Electronic Medical Record, to be precise; with it, any patient's life from birth to death could be recalled at the touch of a button. One day I was leafing though a luxurious, thick chart; the next I was struggling to type the name Deirdre with one finger while precious clinical time oozed away. When I entered a note about patient Deirdre or Donald, the computer would freeze and I'd lose all I'd written; mostly, I felt like throwing the contraption out the window and into the snow. (I never told this to the Computer People, who logged all my difficulties, poking at their PDAs with a little stick.)

The sad fact was this: the Computer People had convinced our clinic to “go electronic,” and $100 000 later we were committed. There could be no return to paper from a regime of triple passwords that couldn't be a personal name, or contain more than one capital letter, three numbers or fewer than eight characters. To-Do pop-ups, Alert Actions, Electronic Signatures and Correspondence Control Centres must forever rule.

A handful of doctors quit our group practice in frustration. Inscrutable, the Computer People watched them go. Each time a colleague left, I wished I could pull out a particularly fat chart, toss it in the air and make the Computer People restore every single piece to order. Because that's how hard learning the new system felt for me. It is counterintuitive, a barrier between patient and doctor. Instead of sitting down, facing the patient and taking a history, we must interact with a computer screen. Already patients have complained that the doctor is “more interested in his computer than he is in me.”

I think this secretly makes the Computer People happy. They patrol the clinic perimeter, available to address any “problems” —which they privately believe to reside with us, the users. (One can tell by their solicitude, their unruffledness.) Computer problems may bog down morning clinics, things may be brought to a standstill until a glitch is resolved, and they will never understand the urgency of a doctor behind schedule. They do not arrive winded. They glide in like emperors of the Internet. And because of these computer problems — ours or theirs? — all the doctors are behind schedule. Every day.

The Computer People are thus kept in demand.

— Dr. Ursus