The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age By Robert M. Wachter

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The New York Times Science Bestseller from Robert Wachter, Modern Healthcare’s #1 Most Influential Physician-Executive in the US While modern medicine produces miracles, it also delivers care that is too often unsafe, unreliable, unsatisfying, and impossibly expensive. For the past few decades, technology has been touted as the cure for all of healthcare’s ills. But medicine stubbornly resisted computerization – until now. Over the past five years, thanks largely to billions of dollars in federal incentives, healthcare has finally gone digital. Yet once clinicians started using computers to actually deliver care, it dawned on them that something was deeply wrong. Why were doctors no longer making eye contact with their patients? How could one of America’s leading hospitals give a teenager a 39-fold overdose of a common antibiotic, despite a state-of-the-art computerized prescribing system? How could a recruiting ad for physicians tout the absence of an electronic medical record as a major selling point? Logically enough, we’ve pinned the problems on clunky software, flawed implementations, absurd regulations, and bad karma. It was all of those things, but it was also something far more complicated. And far more interesting . . . Written with a rare combination of compelling stories and hard-hitting analysis by one of the nation’s most thoughtful physicians, The Digital Doctor examines healthcare at the dawn of its computer age. It tackles the hard questions, from how technology is changing care at the bedside to whether government intervention has been useful or destructive. And it does so with clarity, insight, humor, and compassion. Ultimately, it is a hopeful story. "We need to recognize that computers in healthcare don’t simply replace my doctor’s scrawl with Helvetica 12," writes the author Dr. Robert Wachter. "Instead, they transform the work, the people who do it, and their relationships with each other and with patients. . . . Sure, we should have thought of this sooner. But it’s not too late to get it right." This riveting book offers the prescription for getting it right, making it essential reading for everyone – patient and provider alike – who cares about our healthcare system.

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I'm a retired (disabled) 64 yo internist living in St Louis. I loved everything about medical practice except for the GDC (gosh darned computer). I lived through the nightmare of transitioning from paper to electronics. Hard and expensive enough by itself. Felt it intruded in the patient physician relationship. Shortly thereafter, Meaningful Abuse standards came into existence. Even more onerus. I can't say electronics are all bad The book is slightly dated, but the history is accurate and many issues mentioned in the book still exist.I was an owner/employee of an 80 doc group in St Louis. We needed a new EHR. We checked out vendors. The 2000# gorilla, Epic, woud not demo their product because we were "too small" (although we would have liked to use the same EHR as the local hospitals). We chose NextGen. Problem 1. Getting it up and running. Our group has to date asked for over 14,000 recommendations to the code writers to try to improve work flow. Problem 2 Our EHR couldn't talk to the hospitals' Epic systems. Problem 200. As pointed out in the book by a practioner trying to meet Meaningful Abuse standards, I also had a large library of patient handouts on numerous disease states. When confronted by computer stupidness requiring me to print out "their" version (often useless), I would do so to meet meaingful use standards. I would then trash the printed copy and give them my own version.Current issues for primary care docs. Information unavailability. Reports scanned into the chart often end up in places in which I would have never looked. Inability to seamlessly transfer my medical notes to anyone outside of my EHR system. (Interestingly, Barnes Hospital here uses a different version of NextGen, and our computers can't talk to one another). Docs "ignoring" their patients in the exam rooms while trying to click check boxes on the GDC (in retrospect, I should have employed a scribe, despite the perceived presence of a total stranger in the exam room.) I lament the loss of patient/doc "direct" contact (I was guilty of that, too). Spending most of one's time trying to please the computer's and government's masters DEFINITELY impaired my doc/patient relationship. I truly believe that actually getting the patient undressed and "laying on hands" (i.e. actually doing a clinical exam) is both helpful figuring things out medically, and emotionally helping patients trust us docs. And finally for now, I agree having access to the latest in computerized knowledge (I used UpToDate) helped me provide optimal healthcare to my patients.

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