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“Some Food (or Electronics) For Thought”

These past 10-20 years and the next 10-20 years probably represent a sort of “bridge” leading from one way of life to another way of life. “Electronics” has been impacting so many aspects of our lives, including our personal / home life, our educational life, our recreational life, our politics, certainly the way we shop, and to be sure, the religious, moral, legal, and ethical influences on our lives as well. Of course, we are now seeing that our “health life” is under siege by “electronics.” We (Mr. and Mrs. Citizen) probably have never had a more common thread tying all of these influences together before. Historically or traditionally, as goals for living our lives, we certainly have attempted to maintain a separation of church and state, personal and professional life, family and non-family, political and non-political, or legal and illegal, to suggest a few of our societal goals.

Fairly recently, we (the healthcare industry) came to the conclusion that a better informed patient and a more involved patient makes for a healthier patient as well as a more efficient clinician / patient relationship. So a major collective effort has been to better inform patients and at the same time give them more autonomy and hopefully bring them deeper into the decision-making process.

We’ve made the PDR (Physician’s Desk Reference) available to the public; we increased the volume and depth of TV and other media advertisements and exposures to medicines, disease states, and diagnostic and maintenance processes. We started to combine TV entertainment and medicine in the 1950s with the show “Medic” (TV’s first doctor drama starring Richard Boone who later turned in his stethoscope for a gun in “Have Gun Will Travel”). This show helped pave the way for “Ben Casey” and “Marcus Welby.” These were early medical shows that were written to give audiences a so-called “real” perspective into medical practice as opposed to the earlier movies of the 1920s-1930s (i.e. Dr. Kildare) where the personal drama / plot overshadowed issues of medical practice. In the past few years, issues of medical practice have become more prominent in shows as a number of medical shows have incorporated non-professional actors and licensed clinicians going through real live diagnosing and treatment on camera. All of this, in addition to selling products, is an effort to give more empowerment to people and make them better educated with regard to health maintenance. To this end, we are now beginning to see patient information being gathered / taken faster, in greater volume, stored in quicker, retrievable modes, and being made more available and transferable.

This mechanical management of patient records is being referred to as EHR (Electronic Health Records). As use of EHR increases, we must become more alert to “liabilities” in using EHRs. For example, “copying and pasting” can be a source of mis-managing information. Another concern might be who should have access to “passwords” in an office? Again, the more people that have password access, the more potential for the mis-management of information as well as the potential for the “hacking” into patient information. It has been reported that there is a “Black Market” for stolen patient information (EHR charts) for use in stealing identities. Isn’t it possible that if clinicians become so engrossed in entering data while in the presence of the patient, the patient may regard this as an erosion of the patient-clinician relationship? There is a growing concern that displeasure with the clinician’s behavior is becoming more of an issue regarding patient satisfaction than the mechanical skills of the clinician.

So, with this increasing movement of electronic information comes a myriad of newer concerns. Along with this growing trend (or process) of increased patient information manipulation are questions relating to “Whose information is this?” “Does someone have ownership, and if so, is it the patient or the clinician?” Who is entitled to see it?” “Who decides how, when, and where to expose it?” “What impact is the “manipulation of patient information” having on the legal and/or ethical concern for privacy / confidentiality?” “Which laws have to be amended?” “What laws have to be written?” “Where should state law begin or end in relation to federal law?” Then there are the issues of age. “What role does a minor play in the ownership of patient information and then what age should the term ‘minor’ apply to?”

If we are heading towards a “one-world-like” control of medical information depository, who should decide which information should be registered and what role should a patient’s age, gender, and marital status play?

As we become more and more involved in amassing electronic information, with or without centralizing, the reality of any system / mechanism / processing being exposed to abuse / fraud has to be considered. The clinician saw the patient, made some notes, and amassed some data for his file in his office. Traditionally, this was done with hard copy; however, more recently it is being done in some computer system adopted by the clinician. Now the trend is developing to transfer this information. We all remember the old adage “The more parts to the product”, or “the more steps to the process,” “the more can go wrong.” In addition, surely, in this day and age, “more” usually means “more cost.” Where will this be absorbed, or by whom?

There is a whole other set of considerations. What will clinicians do? Will they be as complete? Will they have to rethink those responsibilities that are not related to direct patient healthcare such as entering notes, forwarding notes, filtering notes, managing notes differently? Will they be as quick to enter a thought that is meant just for their own reminder?

It appears to me that healthcare clinicians, attorneys, law makers, and ethicists are going to have to engage in closer working relationships, as more “food (or electronics) for thought” emerges.


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