Patient Centered Care?

ANDRIY KATYUKHA, MEDS '22

​Cursory assessment would lead one to prematurely, and dare I say, erroneously, conclude that the Electronic Patient Record (EPR) plays a positive role in improving patient care. Dissenters would be chastised by the majority of people who see the EPR as a centralized reservoir that contains vital details pertaining to a patient’s journey through the healthcare system. It is argued that such details are important in understanding medical presentations and collating the summation of interpretations by practitioners far and wide. I would be remiss to not acknowledge that details and facts are the basis of medical reasoning, and following that logic, a complete electronic account would lead to increased accuracy in the treatment of patients. 

I argue, however, that a complete account is not synonymous with an accurate account. In the most elementary sense, I equate the EPR to a telephone system, via which information is transmitted. Let’s now add some complexity to this system. Each entry in the EPR represents a transmission point, where information is hopefully sent across in its totality to create a sufficient account of “the patient experience”. It is then propagated down the system until it is accessed by an overworked, idealistic resident working an overnight shift in a busy academic centre. The record in the EPR is sacrosanct, and oftentimes not questioned because questioning leads to inefficiency, thus undermining the very goal of this “invaluable system”. The amount of times that incomplete and inaccurate information is scribed into the EPR is too many to count. Our superior communication system quickly deteriorates into nothing more than a broken telephone. It is quite obvious that decisions made on seemingly correct, yet wildly inaccurate information, lead to dismal patient outcomes. 

This reliance on the EPR limits the need for a proper patient led account of an incident, as the information needed for diagnosis has already been collected and rehashed by multiple providers. Why ask the same questions again, if you already have a complete account of the issue presented to you? This function fundamentally undermines what healthcare providers are taught to do—talk to their patients. Conversations become abrupt, and the EPR fills in the details. The model of patient-centered care is slowly eroded and what is left in its place is EPR centered care. This care is detached, hollow, and predicated on a “patient-less” experience.