Those damned computers will drive me to an early retirement. I'm fed up with having to resuscitate fatally flawed programs instead of caring for patients. Nothing irritates me more than having to reboot repeatedly in front of a waiting room full of unsympathetic onlookers. My hardware man and my software man don't answer their pagers. “Try pressing that button,” suggests a well meaning patient.
Back in the examining room, Mrs N is pouring out her troubles when she notices me suddenly tuning her out because the computer screen has gone blank. “Just hold on to that tearfulness, Mrs N, I'll be with you in a moment.” The day will come when I'll put in a claim for worker's disability compensation citing “computer generated stress disorder.”
Since 1998, Israeli health maintenance organisations require that all patient charts be computerised. Patients carry plastic cards with magnetic strips that they present at the clinic in lieu of payment. My secretary passes the card, and, after a cacophony of computer talk, the screen informs us that Big Brother authorises the visit. A patient chart cannot be opened until permission to treat is given. Doctors are not paid unless a patient's plastic card is properly passed. “We've been off line for the past half hour,” she informs me. The cleaning lady, who is looking on, suggests, “Try pressing that button.”
We all learnt about patient centred and disease centred medical care. My approach can best be described as computer centred. This begins every morning the moment I arrive at the clinic. I need to start 30 minutes before any patients appear if I'm to have a chance. Firstly, I check that all three computers are still working and haven't been sabotaged by a midnight power outage. Next, I check if the program backing up the patient charts kicked in properly. Often it hasn't, which is why we have a backup for the backup. Finally, I need to connect to my insurance carriers via the modem. If everything is working as it should, my modem receives all the day's laboratory, x ray, and other ancillary test results. Did I say computers were all bad?
But sometimes, Big Brother loses track of what he has already sent me, and I receive results of throat cultures from four months ago. I'm up to lab result number 84, and the program cannot be shut off. The only way to halt this parade is to reboot again.
My partner feels much like me. Whenever we have a few moments to sit down together over coffee, instead of talking about the day's interesting patient, we talk about what went wrong with our electronic gadgetry. We commiserate with each other, and no one else seems to understand. To make matters worse, for every computer problem that pops up there's a well meaning nudnik nearby with a quick fire solution to offer or, at the very least, has a brother in law who does. I usually follow the cleaning lady's advice when she says, “Try pressing that button.”
Footnotes
We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.