Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Embracing the EMR

Maintain eye contact with your patient if and when you're typing in the electronic medical record (EMR).


The best gift we can give our patients is our undivided attention. Maintain eye contact with your patient if and when you’re typing in the electronic medical record during the encounter.

Connecting with Patients | December 15, 2020 | 1 min read

By Alice Rothchild, MD, Seattle, WA

After decades of work as an OB-GYN and numerous experiences as a patient, I came to understand that one of the most important gifts we can give our patients is our undivided attention. This aspect of care is sometimes overlooked and undervalued. There’s no billing code for empathetic listening.


Before the EMR, making time to just listen was easier, as entering data was less time consuming and insurance companies had a minimal grip on what we had to do and how we spent our time. There were medical records department and transcribers who helped us. Don’t get me wrong, I’m not a Luddite—I understand that the EMR has greatly improved our standardization of quality of care and access to the bits and pieces of the medical record. But that’s come at a price.


Years ago, I was part of a medical practice where an EMR system was tested and rolled out. I realized that the prewritten histories—with drop downs, suggested texts, formulaic plans, and ornery billing codes—could change the way I thought, what questions I asked, and how I managed my time. At first I rebelled, wrote most charts by hand, and then spent hours entering the data long after my children were asleep. I was spending more time typing than doing surgery. This wasn’t sustainable. After mastering typing while maintaining eye contact, composing my own prewritten homemade smart texts and phrases, and making time for some data entry after the visit, here’s what I suggest to make the most of the EMR:


1. Ask open ended questions when checking off boxes.

Don’t assume an answer, or sound like you’re checking off a box.  Ask , “Do you smoke?” instead of,
“You don’t smoke, do you?”


2. Listen without interrupting, and maintain eye contact. Sit at the same level as your patient.


3. Take advantage of all technology offers.

Show patients graphs of their weight and blood pressure, x-ray results, write personalized after-visit summaries in normal English, and use patient portals for secure email conversations. Make the computer a helpful and positive part of care that augments the relational aspects of care.


4. Give patients as much access to their records as possible to empower them to take control of their health.