"Changing nature of medicine: our jobs are not the same as Osler's" and Dr Abraham Verghese presentation at #ACAAI16

This is a Twitter summary from #ACAAI16 meeting. The post is a part of series. See the rest here: http://allergynotes.blogspot.com/search/label/#ACAAI16

Several allergists did a great job posting updates on Twitter from the 2016 meeting of ACAAI, the hashtag was #ACAAI16. I used the website Symplur to review the tweets:

@mrathkopf @dryesimdem @dranneellis @allergykidsdoc @drsilge

http://www.symplur.com/healthcare-hashtags/acaai16/

Presentation handouts are available from the ACAAI website: http://annualmeeting.acaai.org/session_presentations.cfm

"Not everything that can be counted, counts. Not everything that counts can be counted" - Abraham Verghese MD.

The Keynote Speaker Dr. Abraham Verghese (@cuttingforstone): "The care in caring, finding what is timeless in an era of change".

The Care in Caring....High-touch in a high-tech area - Dr Verghese: https://t.co/B4VRkWQuE8

In the near future, we will have much more than history & physical exam: genome, microbiome, biosensors, social profiling #BigData

Verghese paints a futuristic picture of what MDs may evaluate soon. Social network, genome, microbiome, history, imaging...

Percussion was initially performed with a hammer and a pleximeter. Laennec described "Le cylinder" which later became the stethoscope. Led the transformation from barber surgeon to physician. Carrying a stethoscope in your pocket was a symbol that you were someone wanting to cure and heal.

Verghese discussed Fildes' "The Doctor": https://t.co/rgxDGX2KnQ

The singular attentiveness of the physician in the painting "The Doctor" reflects what all of us hope for from our health care provider. If "The Doctor" were painted now he would be staring at a computer screen rather than the sick girl. "Rounds" take place in board rooms now rather than at the bedside.

Loss of eye contact during patient encounters secondary to EHR clearly shown to increase patient dissatisfaction, unsurprisingly. Physicians spend more time looking at computer screens than making eye contact with patients.

Looks like a great paper "4000 Clicks - a productivity analysis of EMRs in a community hospital" Hill et al. AJEM 2013; 31, 1591-94. "4000 clicks a day" - the average emergency medicine doctor clicks on EMR 4000 times a day, major contributor to physician burnout. "Physicians are the highest paid clerical workers in the country".

For every hour a physician spends with a patient, they spend 2 with the electronic health record.

Verghese published a paper in the AJM - a collection of vignettes of inadequacies of physical exam as cause of medical error. If we don't listen to the patient, if we don't do a physical examination, legions of errors will occur. Patients can tell when you've done a sloppy physical exam the same way we can pick up a sloppy chef or mechanic.

"The secret of the care of the patient is in caring for the patient" - Peabody.

Dr Verghese references the IOM report "Improving Diagnosis in Healthcare": https://t.co/auFx2I5w8E

Verghese discussed a movement at Stanford U on promoting the culture of bedside medicine @cuttingforstone: https://t.co/YrSJ72ugdh

"The EHR as it currently exists is a mistake of epic proportions" & prevents physician direct attention to patient”: https://t.co/Edr0vgPrio

@drsilge: Curious as to how how much of this resentment is just conservatism railing against changing nature of medicine. The paper chart can't contain genomic info, digital recordings, etc. Our jobs are not the same as Osler's.

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