Skip to main content
Part of complete coverage from

Doctor, LOOK at me

By Bob Greene
March 9, 2014 -- Updated 1322 GMT (2122 HKT)
Bob Greene says something is lost when doctors have to pay attention to electronic devices rather than to their patients.
Bob Greene says something is lost when doctors have to pay attention to electronic devices rather than to their patients.
STORY HIGHLIGHTS
  • Bob Greene: Doctors taking notes on computer interferes with doctor-patient visit
  • He says electronic records mandate may keep them from assessing patient visually
  • He says visits are precious opportunities for face-to-face discussion
  • Greene: Doctors must find a way to solve this for the sake of doctor-patient relationship

Editor's note: CNN Contributor Bob Greene is a bestselling author whose 25 books include "Late Edition: A Love Story," "Duty: A Father, His Son, and the Man Who Won the War," and "Once Upon a Town: The Miracle of the North Platte Canteen," which has been named the One Book, One Nebraska statewide reading selection for 2014.

(CNN) -- They are six of the most powerful words in the English language:

"The doctor will see you now."

Physicians themselves rarely hear them. But to the people who do -- the patients in the waiting room -- they can spur emotions ranging from hope to fear to gratitude to anxiety to dread.

Which is why what has happened, in recent years, as patients step into examining rooms has had such a profound effect on the experience of a visit to the doctor. There have been two changes, prompted by federal initiatives whose genesis predated the Affordable Care Act, that have altered a comforting routine essential to the physician-patient relationship for centuries.

Bob Greene
Bob Greene

The doctor today is not likely to look for long into the eyes of the patient. As the physician begins asking questions and taking a history, he or she may be tapping away at a computer keyboard, peering at the screen, entering information as the patient responds to queries. It can be jarring, the first time a patient encounters it. The importance of eye contact with a doctor does not become evident until it's gone.

There is a reason that physicians have shifted their eyes away from their patients and toward those screens; it is not that the doctors have cavalierly decided to become rude. The mandated use of electronic medical records, with the government providing cash incentives for physicians who agree to use them, and threats of eventual penalties for those who don't, has forced doctors, many of them reluctantly, to become data-entry clerks as they conduct their examinations.

This matters, and not in a good way. There is something about the presumed intimacy of a conversation with one's doctor -- of patient and physician looking into each others' eyes, with the physician reading the expression on the patient's face as well as listening to the patient's words -- that is key to what medical care, with the emphasis on "care," has always been about. Part of this may be mutually understood illusion; on some level the patient is aware that the doctor probably has a half-dozen patients, right at this moment, in examining rooms up and down the hallway, waiting for his or her attention.

But the time that one spends with the doctor is supposed to feel like a heart-to-heart conversation, one human being talking about exceedingly private things to another. The patient has made plans for this visit, has traveled to it, has come prepared with a list of concerns and worries. When the doctor, obedient to 21st-century regulations, turns away and begins to communicate not with the patient but with a screen, something intangible and consequential is lost. Is the doctor really seeing you now?

Robots as pharmacists?
Doctor's office in a box
Baby boomers causing doctor shortage
Doctors' notes empower patients

The changes have been instituted in the name of efficiency: "evidence-based decision support," "quality management," "streamlining the clinician's workflow," among other jargon used to justify the decreed new methods. Electronic records can make coordination between a patient's various physicians more seamless, can provide information about a patient's history quickly in emergencies, can be helpful in ascertaining that treatment options being considered in different offices do not duplicate or conflict with each other. And, without question, as the world moves from records kept on paper to digital storage, revisions in the workings of doctors' offices were necessary.

Yet as medical organizations, insurance companies and the federal government all make their cases for what works best, the one constituency -- such a cold word -- that seems to be left out is the patients. Some of whom have always felt a little awkward raising questions about what goes on in their physicians' offices. It is not easy, in that examining room, for a woman or a man to say to the doctor: "Could you please look at me when we talk?"

Some doctors -- the ones who can afford it -- have come up with what seems to be a solution to the new regulations. Transcriptionists, sometimes referred to as scribes, have been retained to move with the doctor from one examining room to the next, carrying laptop computers or tablets, listening as the doctor and patient speak, typing the requisite information.

This allows the doctor to talk with the patient the old way: eye-to-eye. But it creates a different problem. There is a stranger in the room. For some, perhaps many, patients, the kinds of things they want to discuss with their longtime doctor are not the kinds of things they want to say in front of third parties. That illusion of intimacy, again, that feeling of privacy -- it becomes broken. The elderly patient who may have been going to the same doctor for decades, now being expected to sit, undressed, in the presence not just of that trusted doctor, but of a transcriptionist listening in and clicking keys ... something is lost.

The best and most compassionate doctors can make anything work. They do it every day. But the bureaucrats, however well-intentioned, who came up with these changes may have lost sight of another time-honored phrase in the healing arts, the most sacrosanct of all. It refers to the general practice of medicine, but it also applies to the doctor-patient relationship:

First, do no harm.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Bob Greene.

ADVERTISEMENT
Part of complete coverage on
December 27, 2014 -- Updated 0127 GMT (0927 HKT)
The ability to manipulate media and technology has increasingly become a critical strategic resource, says Jeff Yang.
December 26, 2014 -- Updated 1617 GMT (0017 HKT)
Today's politicians should follow Ronald Reagan's advice and invest in science, research and development, Fareed Zakaria says.
December 26, 2014 -- Updated 1319 GMT (2119 HKT)
Artificial intelligence does not need to be malevolent to be catastrophically dangerous to humanity, writes Greg Scoblete.
December 26, 2014 -- Updated 1505 GMT (2305 HKT)
Historian Douglas Brinkley says a showing of Sony's film in Austin helped keep the city weird -- and spotlighted the heroes who stood up for free expression
December 26, 2014 -- Updated 1303 GMT (2103 HKT)
Tanya Odom that by calling only on women at his press conference, the President made clear why women and people of color should be more visible in boardrooms and conferences
December 26, 2014 -- Updated 1312 GMT (2112 HKT)
When oil spills happen, researchers are faced with the difficult choice of whether to use chemical dispersants, authors say
December 25, 2014 -- Updated 0633 GMT (1433 HKT)
Danny Cevallos says the legislature didn't have to get involved in regulating how people greet each other
December 23, 2014 -- Updated 2312 GMT (0712 HKT)
Marc Harrold suggests a way to move forward after the deaths of NYPD officers Wenjian Liu and Rafael Ramos.
December 24, 2014 -- Updated 1336 GMT (2136 HKT)
Simon Moya-Smith says Mah-hi-vist Goodblanket, who was killed by law enforcement officers, deserves justice.
December 24, 2014 -- Updated 1914 GMT (0314 HKT)
Val Lauder says that for 1,700 years, people have been debating when, and how, to celebrate Christmas
December 23, 2014 -- Updated 2027 GMT (0427 HKT)
Raphael Sperry says architects should change their ethics code to ban involvement in designing torture chambers
December 24, 2014 -- Updated 0335 GMT (1135 HKT)
Paul Callan says Sony is right to call for blocking the tweeting of private emails stolen by hackers
December 23, 2014 -- Updated 1257 GMT (2057 HKT)
As Christmas arrives, eyes turn naturally toward Bethlehem. But have we got our history of Christmas right? Jay Parini explores.
December 23, 2014 -- Updated 0429 GMT (1229 HKT)
The late Joe Cocker somehow found himself among the rock 'n' roll aristocracy who showed up in Woodstock to help administer a collective blessing upon a generation.
December 23, 2014 -- Updated 2115 GMT (0515 HKT)
History may not judge Obama kindly on Syria or even Iraq. But for a lame duck president, he seems to have quacking left to do, says Aaron Miller.
December 23, 2014 -- Updated 1811 GMT (0211 HKT)
Terrorism and WMD -- it's easy to understand why these consistently make the headlines. But small arms can be devastating too, says Rachel Stohl.
December 22, 2014 -- Updated 1808 GMT (0208 HKT)
Ever since "Bridge-gate" threatened to derail Chris Christie's chances for 2016, Jeb Bush has been hinting he might run. Julian Zelizer looks at why he could win.
December 20, 2014 -- Updated 1853 GMT (0253 HKT)
New York's decision to ban hydraulic fracturing was more about politics than good environmental policy, argues Jeremy Carl.
December 20, 2014 -- Updated 2019 GMT (0419 HKT)
On perhaps this year's most compelling drama, the credits have yet to roll. But we still need to learn some cyber lessons to protect America, suggest John McCain.
December 22, 2014 -- Updated 2239 GMT (0639 HKT)
Conservatives know easing the trade embargo with Cuba is good for America. They should just admit it, says Fareed Zakaria.
December 20, 2014 -- Updated 0112 GMT (0912 HKT)
We're a world away from Pakistan in geography, but not in sentiment, writes Donna Brazile.
December 19, 2014 -- Updated 1709 GMT (0109 HKT)
How about a world where we have murderers but no murders? The police still chase down criminals who commit murder, we have trials and justice is handed out...but no one dies.
December 18, 2014 -- Updated 2345 GMT (0745 HKT)
The U.S. must respond to North Korea's alleged hacking of Sony, says Christian Whiton. Failing to do so will only embolden it.
December 19, 2014 -- Updated 2134 GMT (0534 HKT)
President Obama has been flexing his executive muscles lately despite Democrat's losses, writes Gloria Borger
ADVERTISEMENT