The generation gap in physician digital communications
March 07, 2018
by Sean Ruck
, Contributing Editor
Dr. Bryan Vartabedian is the director of community medicine at Texas Children's Hospital.
In addition to shaping the country's first longitudinal curriculum for digital communication in undergraduate medical education, his blog, 33 charts, has evolved as a hotspot for dialogue around doctors and technology. HealthCare Business News spoke with him about how different generations of clinicians handle communication technologies.
"When I first went into practice, I was in a small office by myself working on paper and really, the only person who saw my notes was me," he says.
Sharing notes required requests and copies. It was a process. With the rise of the EHR, portability has gone up, as has accountability.
"I work in a large hospital system now, so people can see my notes at a click. There are far more people reading what I'm composing now," he says.
According to Vartabedian, although doctors frequently complain about EHRs being a problem, even if the brightest minds in Silicon Valley were to design the perfect EHR, the mid-career physicians would still be miserable. He believes physician dissatisfaction is not a design problem, but rather a regulation problem.
Yet it seems that it may not be much of a problem for up-and-coming physicians.
"It's an interesting [phenomenon]. Texas Children's Hospital has the largest pediatric residency in the U.S. and if you were to survey our 129 residents, all in their mid-20s, you likely wouldn't hear a complaint about our EHR," he says.
The key, he believes, is that the younger generation was raised understanding how to navigate a screen and keyboard interface while working.
"I remember maybe five years ago, we had the first residents who had never held a paper chart before. That was kind of a revolutionary turn in my mind," he says.
Millennials aren't challenge-free when it comes to digital communications. That's why Vartabedian created his digital communications curriculum for med students. He explains that it was initially created as a course on how to use social media, but evolved to include the broader issues that doctors face with technology.
"When we think about how we interface with technology, whether EHR or communication technology like social media, there's really very little training that takes place between medical school and residency that helps medical students and post-graduate trainees navigate life with technology," he says.
One of the challenges facing physicians is the balanced use of the EHR with face-to-face patient interaction. While there's a tendency to blame technology for the failure to connect, Vartabedian thinks that thinking more intentionally about our clinic interactions would solve some of the issues.
"So one of the things I'm big on is sharing the way I design my in-room experience with patients,” he said. “I'm very deliberate in my structure. I take the first 10 minutes or so collecting data and that's where I type. Then, I pull away from the computer and have the face-to-face with the patient. I'm very conscious of how I interact to minimize the impact of screen time."
Vartabedian believes the same approach needs to be part of med school training. While there are documentation regulations, physicians have far more agency than they're given credit for.
"We see all this technology as being very deterministic when, in fact, I've designed my experience to collect the information I need and then spend time with the family."
Speaking of the family, that's an evolution that's not talked about enough in Vartabedian's estimation.
"As a pediatrician, I often deal with two generations in the exam room, a grandmother and mother. What's really interesting is that millennial mothers are often comfortable not making eye contact, but I've seen many instances where grandparents clearly need eye contact, so when I'm in the exam room, I find myself adapting based on the generational needs of the patient."
He believes that the rise of machine learning and the next generation of AI have the potential to not only improve health care, but they may help doctors who want to avoid screen time. Smart machines, he predicts, have the potential to help physicians do the things they do best – spend more time with patients.
"I think we'll see the emergence of machine learning that can take apart a conversation and help construct basic notes and records."
His prescription for the younger generation is to stay cognizant of the need to create human connections between physician and patient. But being techno optimistic, he believes physicians can be active participants who can innovate technology and shape its appropriate use after it's released into the clinical space.