Skip to main content
Part of complete coverage from

Doctor, LOOK at me

By Bob Greene
updated 9:22 AM EDT, Sun March 9, 2014
Bob Greene says something is lost when doctors have to pay attention to electronic devices rather than to their patients.
Bob Greene says something is lost when doctors have to pay attention to electronic devices rather than to their patients.
STORY HIGHLIGHTS
  • Bob Greene: Doctors taking notes on computer interferes with doctor-patient visit
  • He says electronic records mandate may keep them from assessing patient visually
  • He says visits are precious opportunities for face-to-face discussion
  • Greene: Doctors must find a way to solve this for the sake of doctor-patient relationship

Editor's note: CNN Contributor Bob Greene is a bestselling author whose 25 books include "Late Edition: A Love Story," "Duty: A Father, His Son, and the Man Who Won the War," and "Once Upon a Town: The Miracle of the North Platte Canteen," which has been named the One Book, One Nebraska statewide reading selection for 2014.

(CNN) -- They are six of the most powerful words in the English language:

"The doctor will see you now."

Physicians themselves rarely hear them. But to the people who do -- the patients in the waiting room -- they can spur emotions ranging from hope to fear to gratitude to anxiety to dread.

Which is why what has happened, in recent years, as patients step into examining rooms has had such a profound effect on the experience of a visit to the doctor. There have been two changes, prompted by federal initiatives whose genesis predated the Affordable Care Act, that have altered a comforting routine essential to the physician-patient relationship for centuries.

Bob Greene
Bob Greene

The doctor today is not likely to look for long into the eyes of the patient. As the physician begins asking questions and taking a history, he or she may be tapping away at a computer keyboard, peering at the screen, entering information as the patient responds to queries. It can be jarring, the first time a patient encounters it. The importance of eye contact with a doctor does not become evident until it's gone.

There is a reason that physicians have shifted their eyes away from their patients and toward those screens; it is not that the doctors have cavalierly decided to become rude. The mandated use of electronic medical records, with the government providing cash incentives for physicians who agree to use them, and threats of eventual penalties for those who don't, has forced doctors, many of them reluctantly, to become data-entry clerks as they conduct their examinations.

This matters, and not in a good way. There is something about the presumed intimacy of a conversation with one's doctor -- of patient and physician looking into each others' eyes, with the physician reading the expression on the patient's face as well as listening to the patient's words -- that is key to what medical care, with the emphasis on "care," has always been about. Part of this may be mutually understood illusion; on some level the patient is aware that the doctor probably has a half-dozen patients, right at this moment, in examining rooms up and down the hallway, waiting for his or her attention.

But the time that one spends with the doctor is supposed to feel like a heart-to-heart conversation, one human being talking about exceedingly private things to another. The patient has made plans for this visit, has traveled to it, has come prepared with a list of concerns and worries. When the doctor, obedient to 21st-century regulations, turns away and begins to communicate not with the patient but with a screen, something intangible and consequential is lost. Is the doctor really seeing you now?

Robots as pharmacists?
Doctor's office in a box
Baby boomers causing doctor shortage
Doctors' notes empower patients

The changes have been instituted in the name of efficiency: "evidence-based decision support," "quality management," "streamlining the clinician's workflow," among other jargon used to justify the decreed new methods. Electronic records can make coordination between a patient's various physicians more seamless, can provide information about a patient's history quickly in emergencies, can be helpful in ascertaining that treatment options being considered in different offices do not duplicate or conflict with each other. And, without question, as the world moves from records kept on paper to digital storage, revisions in the workings of doctors' offices were necessary.

Yet as medical organizations, insurance companies and the federal government all make their cases for what works best, the one constituency -- such a cold word -- that seems to be left out is the patients. Some of whom have always felt a little awkward raising questions about what goes on in their physicians' offices. It is not easy, in that examining room, for a woman or a man to say to the doctor: "Could you please look at me when we talk?"

Some doctors -- the ones who can afford it -- have come up with what seems to be a solution to the new regulations. Transcriptionists, sometimes referred to as scribes, have been retained to move with the doctor from one examining room to the next, carrying laptop computers or tablets, listening as the doctor and patient speak, typing the requisite information.

This allows the doctor to talk with the patient the old way: eye-to-eye. But it creates a different problem. There is a stranger in the room. For some, perhaps many, patients, the kinds of things they want to discuss with their longtime doctor are not the kinds of things they want to say in front of third parties. That illusion of intimacy, again, that feeling of privacy -- it becomes broken. The elderly patient who may have been going to the same doctor for decades, now being expected to sit, undressed, in the presence not just of that trusted doctor, but of a transcriptionist listening in and clicking keys ... something is lost.

The best and most compassionate doctors can make anything work. They do it every day. But the bureaucrats, however well-intentioned, who came up with these changes may have lost sight of another time-honored phrase in the healing arts, the most sacrosanct of all. It refers to the general practice of medicine, but it also applies to the doctor-patient relationship:

First, do no harm.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Bob Greene.

ADVERTISEMENT
Part of complete coverage on
updated 2:25 PM EST, Fri November 21, 2014
Maria Cardona says Republicans should appreciate President Obama's executive action on immigration.
updated 7:44 AM EST, Fri November 21, 2014
Van Jones says the Hunger Games is a more sweeping critique of wealth inequality than Elizabeth Warren's speech.
updated 6:29 PM EST, Thu November 20, 2014
obama immigration
David Gergen: It's deeply troubling to grant legal safe haven to unauthorized immigrants by executive order.
updated 8:34 PM EST, Thu November 20, 2014
Charles Kaiser recalls a four-hour lunch that offered insight into the famed director's genius.
updated 3:12 PM EST, Thu November 20, 2014
The plan by President Obama to provide legal status to millions of undocumented adults living in the U.S. leaves Republicans in a political quandary.
updated 10:13 PM EST, Thu November 20, 2014
Despite criticism from those on the right, Obama's expected immigration plans won't make much difference to deportation numbers, says Ruben Navarette.
updated 8:21 PM EST, Thu November 20, 2014
As new information and accusers against Bill Cosby are brought to light, we are reminded of an unshakable feature of American life: rape culture.
updated 5:56 PM EST, Thu November 20, 2014
When black people protest against police violence in Ferguson, Missouri, they're thought of as a "mob."
updated 3:11 PM EST, Wed November 19, 2014
Lost in much of the coverage of ISIS brutality is how successful the group has been at attracting other groups, says Peter Bergen.
updated 8:45 AM EST, Wed November 19, 2014
Do recent developments mean that full legalization of pot is inevitable? Not necessarily, but one would hope so, says Jeffrey Miron.
updated 8:19 AM EST, Wed November 19, 2014
We don't know what Bill Cosby did or did not do, but these allegations should not be easily dismissed, says Leslie Morgan Steiner.
updated 10:19 AM EST, Wed November 19, 2014
Does Palestinian leader Mahmoud Abbas have the influence to bring stability to Jerusalem?
updated 12:59 PM EST, Wed November 19, 2014
Even though there are far fewer people being stopped, does continued use of "broken windows" strategy mean minorities are still the target of undue police enforcement?
updated 9:58 PM EST, Mon November 17, 2014
The truth is, we ran away from the best progressive persuasion voice in our times because the ghost of our country's original sin still haunts us, writes Cornell Belcher.
updated 4:41 PM EST, Tue November 18, 2014
Children living in the Syrian city of Aleppo watch the sky. Not for signs of winter's approach, although the cold winds are already blowing, but for barrel bombs.
updated 8:21 AM EST, Mon November 17, 2014
We're stuck in a kind of Middle East Bermuda Triangle where messy outcomes are more likely than neat solutions, says Aaron David Miller.
updated 7:16 AM EST, Mon November 17, 2014
In the midst of the fight against Islamist rebels seeking to turn the clock back, a Kurdish region in Syria has approved a law ordering equality for women. Take that, ISIS!
updated 11:07 PM EST, Sun November 16, 2014
Ruben Navarrette says President Obama would be justified in acting on his own to limit deportations
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT