Same Shift, Different Day
2021; Lippincott Williams & Wilkins; Volume: 43; Issue: 9 Linguagem: Inglês
10.1097/01.eem.0000791968.01153.58
ISSN1552-3624
Autores Tópico(s)Themes in Literature Analysis
ResumoFigure: EM technology, EM computers, EP lifeFigureMy daughters were 13 and 9 when they, in collusion with their mom, decided we needed a cat. I never had a cat as a kid, always dogs. Cats are moody, aloof, unpredictable, and generally not doglike. Like the alpha male, take-charge-ER-doc type I am, I put my foot down. We didn't get a cat. We got two. One for each of them. In my defense, I made it clear I was not going to take care of them. The deal was for them to feed them, clean the litter box, and give them the attention they needed. The kids are now 25 and 22, and we are empty nesters. Well, not exactly. The cats are still here. The other day as I was cleaning the litter box, I got to thinking, how did this happen? I'm cleaning up cat poop. The answer is it happened slowly. I was broken down. I must admit they have grown on me. I enjoy them, and they give me intermittent positive feedback, which I'm told is the strongest way to reinforce behavior. They come over for a rub, which I think I'm delivering to perfection. Then, all of a sudden, claws out, and I'm quickly schooled. I'm never sure what went wrong. Clearly, I missed the memo about eye contact or something. We actually ended up with three cats. My wife rescued one from a shelter. I never really got the story about how she ended up at the shelter in the first place. It's 15 miles away, not like a just-happened-to-be-in-the-neighborhood deal. Remember that litter box I vowed never to clean? One of the cats decided she would not use it at all. We found little presents on the carpet. We tried getting each her own litter box. Didn't help. We talked to the vet. It turns out cats aren't pack animals like dogs. They are solitary animals and like to be alone. We stressed out our cats instead of creating a perfect little cat community. Not Paper-like It was about 10 years ago when the government and administration decided we needed an electronic health record. I never had an EHR as a new doctor or even for the first 15 years of my career. I was always a paper guy. Computers are moody, unpredictable, demanding, and generally not paper-like. Being that we were a group of independent, alpha ER docs, we said we don't need an EHR. Of course, we were thinking about patient care. Much like my cat protest, it didn't matter; it was a done deal. So we got a cat, I mean, a computer. We said to the IT department, “You guys will have to take care of it, maintain it, and mold it into just what we need.” They said, “Oh, yes, it will be just what you need.” Then came the second cat. No more transcription service. That's too expensive. We were given voice recognition software and told it would get along fine with our EHR. It would talk to our computer, and we could watch it type our note word for word into the medical record. It would be a match made in heaven. Our third “improvement” was the radiology software package. It turns out that computers, while better than cats, I suppose, aren't pack animals either. They generally get along, but often they don't talk to each other or play nice. Sometimes one of them decides to take a break. It needs to have some downtime, you know, a fresh start. Unfortunately, no one is asked when this me time should take place. Often it occurs at the most inconvenient and busiest times in the ED. How about 6 p.m. on a Friday? Perfect, right after everyone gets off work and the doctors' offices close. Not 3 a.m. on a Tuesday. Off to the Races They threaten you too: “I'll dump your work if you don't log off.” No telling what mood they will be in after their nap. Sometimes, I can't tell if they accomplished anything at all. Other times, there's something not quite right about the way my list of favorite orders looks. What's missing? I'm sure that's not important; it will work itself out, and I'm sure it was worth interrupting patient care for that new font. Sometimes they refuse to interact with each other at all. The x-ray was done, but the image wasn't pushed over to the online screen or the report didn't show up in the medical record. Randomly. Like when a cat decides to stop and lick herself, the voice microphone decides not to turn off. Or if I say a word that sounds like one in preprogrammed text, whoa, we are off to the races. I find myself logging off, unplugging, and replugging. I switch workstations and shut down or reboot, all before giving up and filing a ticket. I asked my wife why she moved the glass that holds my toothbrush from the bathroom counter to a shelf. “I caught the cat licking it,” she said, “and I don't think it's the first time.” Great. I'm not sure what the computer equivalent to licking my toothbrush is, but I am certain it is happening as we speak and will be equally disturbing. The other day I was under the desk trying to trace a cable back to its source. My mouse wasn't working. I thought, how did this happen? I'm a doctor under a desk troubleshooting a computer. It's the litter box I vowed not to clean. It's not quite as smelly, but it still stinks. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website, www.EM-News.com. Comments? Write to us at [email protected]. Dr. Harmonis an emergency physician at Marian Region Medical Center in Santa Maria, CA. Read his past columns athttp://bit.ly/EMN-SameShift.
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