I have a confession to make. I'm supposed to love technology. Why? Because
I'm a "young professional" (28-years-old, to be exact) from the generation that
was raised with computers, the internet, and email. Because I started working
in healthcare long after the introduction of the electronic medical record. And
because my peers have hundreds of "Facebook friends," send text messages while
driving, and "Twitter" like it's their job. So here's the confession: I don't
love technology. In fact, it's worse than that. I worry that technology is
eroding the purity of human relationships.
What does this have to do with collaborative care? Everything. As
collaborative care has evolved over the last decades, its bedrock has been the
interdisciplinary relationships among professionals. How did a primary care
physician (PCP) arrange for a suicidal patient to be assessed by a
psychologist? They knocked on the psychologist's door. How did a marriage and
family therapist update a PCP on a patient's success in losing 11 pounds by
walking every evening with their kids? They grabbed the PCP in the hallway.
How did a social worker and PCP decide which patients should be invited to
participate in a new diabetes self-management group? They sat down together and
made a list.
I'm obviously making some of this up, seeing as how I haven't been
practicing collaborative care throughout the last decades. However, you get the
point. Collaboration happened when two providers came together in a good,
old-fashioned face-to-face interaction. Even when only a few words were
exchanged, their tone and body language communicated a tremendous amount. They
might have even parted ways feeling united in the patient's care and empowered
to help the patient effect change.
Now let's consider how each of these collaborations might go differently
today, with the "aid" of technology. The PCP might have sent a message to the
psychologist via walkie-talkie, text pager, or Vocera (a personal communication
device, literally modeled after Star Trek) that "the patient in room seven is in
need of a safety assessment." The marriage and family therapist might have put
a "real time" note in the electronic medical record regarding the patient's
weight loss, expecting the PCP to notice it during the patient's next medical
appointment. The social worker and PCP might have independently mined the
patient registry to generate a list of patients with uncontrolled diabetes
before exchanging emails about how to proceed.
So do I think personal
communication devices, electronic medical records, and patient registries are
bad? Of course not! They are efficient, which is invaluable our fast-paced
healthcare delivery system. They are not human, so they aren't swayed by
subjectivity or as susceptible to error. And they are essentially permanent,
safeguarding against a busy clinician's overwhelmed memory stores. However, I
think these undeniable benefits do not trump the importance of provider
So how do I operate in an increasingly technological healthcare system, while
fully accepting my techno-phobia? I do what any reasonable person does: I
compromise. I try not to email a PCP if they will be in clinic that afternoon,
waiting for a few minutes of candid exchange. I work to make myself as visible
as possible in the clinic, reducing the need for PCPs to rely on the dense
electronic medical record for updates on their patients. And I occasionally go
visit the community agencies to which I refer, so I can provide PCPs with a
personal recommendation for their patients instead of a generic suggestion.
hope is that these extra efforts make for better patient care and stronger
collegial relationships. Whether or not this is true, I am certain that these
extra efforts do keep my passion for collaborative care alive. After all, I'm
in it for the relationships, not the gadgets.