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Wait! What about Good Old-Fashioned Communication?

Posted By Sam Monson, Saturday, January 23, 2010
Updated: Friday, June 10, 2011
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 conversations.

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.

My 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.

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