By Laura De La Torre, MD

The Black Eyed Peas asked, “Where is the love?” and that’s what I wonder, too. As medicine – oops, I’m supposed to say “health care” – has become more and more corporate, what has been slipping away is the love. What do I mean by that? There were specific ways we old docs were trained to care for patients.

Let’s start with bedside manner. We were trained to sit with the patient, look toward their face (looking directly in the eye is not culturally universal), listen with intention, smile, nod, and communicate without jargon. Providers do not have time to do that if they are also expected to type on a computer at the same time. Our eyes are focused on a screen more than they are focused on the patient.

We were trained to do thorough physical examinations. One of the most common patient complaints I hear about other providers is, “S/he never touched me.” If something hurts, it’s our responsibility to examine the part that hurts. Sometimes, that requires the patient to remove clothing – egad, that takes up more minutes of the appointment time! Even if there isn’t a physical complaint, it takes only a few minutes to do a HEENT (head, eyes, ears, nose, and throat), neck, cardiac, and pulmonary examination, and to look at the ankles for edema. Unfortunately, the time available for a clinic visit can be so limited that taking a few minutes to examine the patient will put us behind schedule. Our hands are on a keyboard more than they are on a patient’s body.

We were encouraged to explain things to patients. The patient doesn’t always understand why we want them to take a medication or go for an imaging test. It is not the patient’s duty to do what we say because we say so. They deserve to know why we’re making a recommendation, referring to a specialist, changing a medication, or asking for yet another blood test. A patient recently said to me, “Nobody has ever explained these things to us the way you do, Doctora. NOBODY.” However, we barely have time to enter the orders, much less talk to the patient about it. Our attention is more focused on the chart than the patient.

Without a scribe and with a cumbersome EMR, it can take an additional fifteen minutes per patient to fill out templates, pick the right codes, put in the orders, electronically send every medication to their new pharmacy, use a smartphone to authenticate prescriptions for controlled substances, attach diagnoses, put in referrals, and do all the administrative tasks we are required to do. There simply isn’t time when a patient is scheduled every 20 minutes.

Something’s gotta give. To get it all done during the scheduled visit time and avoid spending nights and weekends charting, the time and attention given directly to the patient when they are in our presence goes by the wayside. There is not enough time to do all the documentation, orders, billing, and coding AND sit with the patient, listen intently, examine their body, and explain why we’re making recommendations to improve their health. They don’t let us doctor the patient. There’s no room for the love.

Laura de la Torre is a family physician.