Healthy Connections

In an age when the patient-physician relationship is becoming increasingly digitized, are doctors losing the ability to bond with their patients?

BY JEN KENT | PHOTOS BY DAVID SZYMANSKI

Dr. W. Craig Leach embraces a key moment in a young patient’s visit: choosing the very best sticker.

will never forget the expression on my husband’s face when our son entered the world. Time stood still, truly, and he beamed with pride. Any bits of fear still lingering from the near-crisis that occurred mere hours earlier immediately evaporated. I was healthy. Our son was healthy. We were grateful.

I try not to think of that near-crisis when I remember our son’s birth day, but, truth be told, it was a significant part of his birth story. And one that, for the zillionth time, made me question if today’s technology-ridden world is turning us all into robots unable to communicate with each other face to face.

In short, my left eye began to significantly droop moments after receiving epidural anesthesia. I was sure I was imagining it, but when I summoned my husband, his worrisome expression confirmed my fear. He buzzed the nurse, who paged the anesthesiology resident on duty. The resident, who appeared to be his early 30s, arrived seconds later, took one (very concerned) look in my direction, and said, “I’ve never seen this before. Let me get my boss.”

I was stunned. Terrified, really. Was I having a stroke? Was the baby OK?

He left the room as quickly as he had entered and returned with the the chief of anesthesiology. The chief immediately came to my side, made eye contact, and assured me that both the baby and I were OK. I was experiencing a benign reaction to the epidural anesthesia. He decreased my dosage, which resolved the issue, and I soon felt at ease.

The chief’s good bedside manner — his direct eye contact and calm demeanor, gentle assurance that we’d be OK, and swift delivery of a solution — had worked its magic. But more than eight months later (and as a 30-something myself) I still wonder why that resident failed to provide compassionate, patient-centric care and if digital devices and the culture they’re creating are, at least in part, to blame.

“You could be standing in your kitchen and just mention the name of a disease [and a question], and Alexa could shout out an answer to you on your digital device,” says Dr. W. Craig Leach, a pediatrician with Bluemound Pediatrics in Brookfield. “… It’s a strange world we live in, sometimes.”

Leach began practicing medicine in the mid ’80s — a time when intrusions on the patient-physician relationship were relatively limited. Medical records were paper-based, doctors had more clinical time with patients, and social media had not yet debuted. Physicians met with their patients in-person, technologies like MyChart and telemedicine were nonexistent and patients had little exposure to the internet and “Dr. Google.”

“Parents [now] have an abundance of knowledge before they come in,” says Leach. “... Very often they are unnecessarily anxious because they heard the worst possible case on the internet. So now they already have a preconceived notion of what’s going on, and they’re scared. … We don’t have as much time as we used to to dissolve that anxiety, so you have to, more or less, bring it right up or cut to the chase.”

To combat these challenges and preserve the integrity of the patient-physician relationship, Dr. Gary Fait, an OB-GYN with more than 30 years of experience and private practices in Cedarburg and Glendale, says he introduces himself to patients as “Gary” and prints out paper copies of each patient’s electronic medical record (EMR) prior to their visit. “I go over [the EMR] and I make notes, so when I talk to the patient, it’s talking face to face. It’s not typing on the EMR and not even looking at them,” he explains, adding that he’s also on call for his patients 24/7. “On the weekends, if one of my patients has a problem, I’ll go open my office and see them.”

Fait adds that he also sees women as soon as they get pregnant, rather than waiting until the customary 8- to 10-week mark. It’s a time when women are feeling most vulnerable, and he is an advocate for, quite simply, being there for his patients. As a recently pregnant woman myself, it’s an attribute I appreciate.

Dr. Jeff Winkoski has practiced family medicine for more than 20 years.

When I recount my own labor and delivery experience (including the resident who failed to provide good bedside manner) to Fait, he empathizes with the situation, saying he fears those who value the physician-patient relationship are a “dying breed.”

Fait has trained residents for 20-plus years, and although he says there’s nothing wrong with young doctors wanting free time, there’s also an expense that comes with that. “If you’re off four out of five, six out of seven or, in some cases, nine out of 10 weekends and your patient goes into labor, you’re not going to have that bond,” he says.

“I try to keep [residents] abreast that everything that they do has costs,” Fait continues. “... They’re more wanting to check off boxes, because that’s what they’re doing in their residencies ‘just in case.’ That ‘just in case’ is so rare. Yes, if you order some of those tests, sometimes you’ll find something. But the majority of the time, if you sit and talk to the patient, you’ll find similar-type stuff. Then you order the test to just confirm what’s going on.”

Dr. Jeff Winkoski, a New Berlin-based family medicine physician with ProHealth Care, says he tries to partner with his patients, knowing there is no one-size-fits-all approach. “There are evidence-based guidelines for things, but the experience [must be] there — the getting to know someone in enough depth to personalize their care,” he adds.

Both Fait and Winkoski’s comments raise an interesting point: Are medical schools and teaching hospitals to blame for the sometimes inadequate training of young physicians in areas like bedside manner, personalized medicine and patient-centered care? Is greater emphasis instead being placed on new tests and technologies?

At its 2016 annual meeting, the American Medical Association said it now encourages medical schools to incorporate telemedicine into their curriculum, and the New York University School of Medicine created a technology-enabled curriculum called Health Care by the Numbers that trains students to use data pulled from clinical (and digital) databases to improve care. There are murmurs that one Milwaukee area health system intends to open an outpatient clinic with no on-site doctors, and all physician-based care administered via telemedicine.

When I broached the subject with a friend who recently completed a pediatric residency and graduated from the Medical College of Wisconsin, his response was surprisingly reassuring. He directed me to look into CASPer — computer-based assessment for sampling personal characteristics — an admissions test that assesses an applicant’s non-cognitive skills and interpersonal characteristics. The 60- to 90-minute online test includes 12 sets of scenarios and questions, and the applicant has five minutes to type his or her answers to the questions. Now a mandatory requirement of the Medical College of Wisconsin’s admissions process, CASPer measures “soft” skills like communication, empathy and problem-solving. 

Dr. W. Craig Leach tends the smallest patients —  and their parents’ biggest worries.

As a patient, knowing that medical schools nationwide are now screening prospective students for non-academic attributes before admittance is, in a word, comforting. Some doctors, however, still aren’t so sure.

“I don’t know what the answer is,” says Fait with a sigh. “Medicine has changed so much. Some for the good, some for the bad.”

The “good” of today’s digital era, says Leach, is a more educated patient population. “[Patients] have a baseline knowledge that is higher than it once was, in many cases,” he adds. “That can be helpful — to start from a higher point when you’re explaining things.”

Patients’ tech-savviness is also undoubtedly higher, and the ease and convenience of online patient portals like MyChart is not lost on digital naysayers. I gratefully used MyChart throughout my entire pregnancy to send messages to my care team and view bloodwork results. Furthermore, physicians’ use of EMRs allows for the easy exchange of data within health systems and between specialists, which can prove advantageous to the patient.

“I think other specialists are realizing we, as internists, can help and support them,” says Winkoski, who willingly collaborates with other doctors caring for his patients to further personalize their care.

Though adapting to — or, rather embracing — the changes health care’s digital era brings may prove a bigger struggle for some physicians and patients, I’m hopeful that capable, seasoned doctors like those interviewed for this story continue to mentor young physicians and stress the importance of the physician-patient relationship. And hopeful that medical schools will do
the same.

“Nothing is quite the same as the physician-patient relationship, and we’re very lucky to be able to participate in that with people,” says Leach. “That’s not going to change, no matter what changes on the outside.” MKE

Do you have a personal story about your own doctor-patient bond or your use of technology to manage your health care? Visit MKE Lifestyle on Facebook and share your thoughts in the comments section of this story.

 

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