In the newsletter of the Texas Chapter of the American College of Physicians, Dr. Steve Urban shares an important concern about Electronic Health Records (EHR).
Dr. Urban writes that EHR is making him a worse doctor. Why? Because computers don't know how to think diagnostically.
Until now, physicians have used the "iterative method" of arriving at a diagnosis: The physician asks a question, listens to the answer, and then asks a follow-up question based on the patient's answer.
In contrast, in the template-driven history of the present illness, a number of boxes are checked and the results dumped into the EHR.
Urban explains, "Computers are great at storing information, okay at prioritizing, and poor at creating.... And diagnosis (in all but the simplest cases) is a creative act. Making a diagnosis is like writing a story that makes sense."
As a clinician, I depended on my history-taking to point me in the right direction. Lab tests and imaging studies were ordered to provide confirmation. Nothing can replace patients' stories, as I explain in What's the Story? and Story Time.
"If you listen carefully to the patient, they will tell you the diagnosis." (Sir William Osler)