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Tuesday Dec 23, 2014

Digital Media: It's Here to Stay, and That's a Good Thing

When I started medical school almost four years ago, I still used paper notes. I printed out lecture slides and scribbled my notes during live lectures. Oftentimes, I had to go back to the recorded, archived lecture to fill in any notes I missed. By the end of the year, my bookshelves were buckling under thick binders full of lecture notes -- notes that I could not readily refer back to because it was too time-consuming to flip through thousands of pages to locate one specific detail. It was faster and easier to search for the information electronically.

This, combined with my desire to be more environmentally conscientious, compelled me to go paperless during my second year in medical school. I downloaded lectures on my laptop and organized them for easy retrieval. I could type my notes more quickly than I could write them, and I could more easily link those notes to specific parts of the lecture. While studying, I used tools on my computer to find keywords and topics within seconds rather than wasting hours leafing through shelves of paper. After making the switch to electronic media, I never looked back.

Not only do electronic files take up less space, but electronic media can be read virtually anywhere and also can be listened to in the car or on the subway.

Now that my medical education has moved beyond the lecture hall into clinics and hospitals where hypothetical scenarios are replaced with real-time patient interactions, easily accessible information is even more important. I cannot bring bookshelves full of notes and clinical pearls from home. And only so much information can fit into a small, white coat-sized notebook. Plus, there's still the issue of quick retrieval. Fortunately, we live in an era when electronic media are readily available. Unlike generations of physicians before me, I only need one information retrieval tool in my white coat pocket -- my smartphone -- and I carry it now more than ever.

From my smartphone, I have quick, easy and unlimited access to the most relevant and up-to-date information I need to verify a diagnosis and/or treatment plan, as well as tools to help me educate patients. Among the electronic resources I use every day are the AAFP website; my medical school library's databases of DynaMed, PubMed and New England Journal of Medicine; and apps such as Epocrates, Micromedex, UpToDate, the American Heart Association's Cardiovascular Risk Calculator, Evernote, and the AAFP journals American Family Physician and Family Practice Management. I can use Dropbox to store my notes and important documents on the Web for retrieval on any of my electronic devices -- my tablet, smartphone or computer.

Some may argue that use of technology in the exam room diminishes meaningful patient interactions and harms the doctor-patient relationship. This has not been my experience. In fact, I would argue that proper use of electronics during a patient visit actually strengthens the interaction and engages patients more fully. For example:

  • There are many instances where the computer screen can be shown to patients, such as when reviewing blood work results, growth or vitals. These numbers and trends can, and should, be shared and discussed with patients.
  • Using electronic health records, various health trends can often be shown on graphs so patients can see how they are doing over time.
  • When documenting/charting patient information, we can let patients see what we are typing and verify with them that the information is correct.
  • Photos can be helpful when reviewing items such as rashes, anatomy or plants they are allergic to, etc. We also can clarify which medications a patient is taking by showing them pictures of the medication on the Epocrates app.
  • And of course, we can use our electronic devices to quickly find an answer to a patient's question when we don't know the answer. 

I have done all of these things, and patients have said that it has made many health topics easier for them to understand and has helped them feel more like a part of their health care team. Many patients appreciate the visuals, especially when they can access them again later at home. 

During one patient interaction, I showed a patient two images of the English plantain, which was the source of his allergy symptoms. One image was a pencil drawing in a book from 1946. The second was a color photograph from Google Images. The patient found the photo more helpful and was happy he would be able to find it later if he forgot what it looked like.

Another reason it is important for physicians to become familiar and comfortable with electronic resources is that our patients are using them. Patients are trying to educate themselves by using the Internet and apps to look up health information and symptoms, track their health and fitness activities, etc. We need to keep up. We need to know what tools they are using and where they are getting their information so that we can guide them to valid, useful facts. 

Are they using Wikipedia, WebMD, Google Scholar, MyFitnessPal, Apple Health, something else? Why are they using certain resources? These are conversations that are important to have. Many patients want to be more engaged in their health. They want to use electronic health tools to access their personal health information through an online portal, track health and fitness goals, and transmit their health data -- such as daily weights, blood pressures, glucose readings -- directly to their medical homes. As physicians, we have to be ready to navigate these new technologies and make them work to our patients' benefit.

Technology will keep moving forward. As it evolves, we need to be sure our ability to use it effectively with our patients does, too.

Kristina Zimmerman is the student member of the AAFP Board of Directors.

Posted at 01:57PM Dec 23, 2014 by Kristina Zimmerman

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.