Dr. Bhoyrul – My Ted Talk
Sunil Bhoyrul, MD
Surgeon, La Jolla, CA
EHR – The inflection point of medicine
EXCELLENCE, HUMANITY, AND RESPECT
My name is Sunil Bhoyrul. I’m a surgeon. Like you, in your passion and profession, I want to do everything to the best of my abilities! I studied hard, read every book, learnt every technical skill I needed to, and keep up to date with every relevant innovation in my field. I work in a state of the art facility, and am surrounded by some really bright, passionate, and caring people. We have every machine that cold possibly go “beep”. Yet, despite all that, things don’t always go as planned.
Harold came to the emergency room – he was bleeding to death. Blood gushing out of his mouth, blood pressure in his boots, the ambulance crew pounding on his chest. Nobody knew him, nobody cared if he had health insurance. He had an almost zero percent chance of surviving!. He came to the right place – we were perfectly equipped to deal with exactly this sort of crisis. All the right people, and all the best technology ready to go! Doctors, Nurses, Surgical techs, even the secretaries did everything according to a well-rehearsed plan. We dropped everything, mobilized every resource we had, fought for hours in surgery, days in the intensive care unit, and weeks on the ward to save his life and, against all odds, got him out of hospital. A truly heroic save!. Unfortunately, during his hospital stay, as a result of the dozens of people being involved in his care, he, almost inevitably, had a preventable complication. Something went wrong. We recognized it, fixed it, owned up to it, and, most importantly, still beat overwhelming odds to save his life. No harm done. As soon as he was well enough to go home, he sued all of us. His attorney said – sue them – that’s why hospitals and doctors carry insurance. I was (and still am) hurt – as were all the people who did their best to save him. Where did we go wrong – how did we get from a 21st century multimillion dollar life saving effort save someones life, and have the same person say nasty things about us in a court of law? We have everything, spend obscene amounts of money, and yet politicians yell at each other, patients complain, and lawyers sue. Something is wrong – how do we fix it?
Well, to understand that, you need to understand how we got here. Medicine is at an inflection point. Until recently, a physician knew everything that could be known, did everything, combined the art and science of medicine with the personality of healer, priest, lawyer, and teacher. Then came the digital age – The digital age has brought vast knowledge and information, that far exceeds the capabilities of a single physician. The key to managing this information is the EHR – the electronic health record
The EHR allows physicians to ability to store, integrate, and manage this vast information. Everything from your chances of developing cancer to how restless your sleep was last night is known by the EHR. The EHR probably defines medicine today as much as the stethoscope did 50 years ago!
The problem with the EHR is that, on its own, it is nothing but a lifeless set of data points. The inhuman experience of the EHR is often the first step in many of the doctor patient problems we see today. In my opinion, we need to breath life back into the EHR, and into medicine itself; We need to redefine it – not as Electronic Health Records, but as Excellence, Humanity, and Respect.
Excellence. Excellence in the digital age is about actively observing your patients. excellence, is about looking at, listening to, and touching your patients, so that they are much more than a set of data points. While in training, my professor asked me to see a patient with pancreatic cancer, and present her on ward rounds. I saw her briefly, and then spent an hour reviewing and memorizing all the blood tests, CAT scans and data on the patient, and reading about all her treatment options. When the time came, I proudly stood outside her hospital room and delivered a perfect presentation to my professor and colleagues. The professor then looked at me, in front of all my fellow students and asked, "What color are her eyes?" At that point, I knew I failed. Without the human connection, the data was useless. To this day, I look in the eyes of every patient, listening to all their questions and lay a hand on every patient. I make it a point to tune out all the environmental noise surrounding us! Without that connection, there can be no excellence. Patients should expect excellence.
Humanity. My definition of humanity in medicine, is focusing not just on WHAT we are doing, but, more importantly on WHY we are here. In an effort to prevent surgical complications, almost every hospital in the country has a mandatory time out to go through a checklist – just like pilots do before every flight. After the patient is prepared, and just before we make the first incision, we verify that we have the correct patient, correct surgery, correct site, correct medications and tools in the room are all part of this impressive time out – its probably much less likely than ever before that your surgeon will make a preventable error. But no mention of why we are all here in the first place – who is the lady with her belly neatly exposed – why is she having surgery? In my operating room, after we finish the Time out, we have a "time in"; a vignette that humanizes our patient, and tells everyone in the operating room why they are getting ready to perform surgery on the human being asleep in front of them. Mrs Smith has stomach cancer – she is a school teacher and her biggest hope is that she gets back to teaching the students that she cares so much about – all her students are on edge today – some of them are even in the surgical waiting room, hoping that she will come back safe and sound. I sincerely believe that if everyone in the operating room knows her story, her outcome is better. Humanity starts when you first meet a patient, and never really ends.
Respect. The story I started off with was one where the respect between the patient and caregivers broke down. Respect is any relationship needs to be mutual. Patients should expect our attention and sincerity, and in the time we are with them care only about their needs – no phones, computers, text messages, and acknowledging their language, religion, age, and even political leanings. Going the extra mile to learn a religious or cultural greeting is a huge sign of personal respect. I will not judge you – please try not to judge me. There needs to be that reciprocity.
So, what is my take home message – next time you meet your doctor – demand EHR – Excellence – Humanity, and Respect. Health care professionals – students, doctors, nurses, administrators – we need to turn electronic data into Excellence – this happens by observing and connecting with our patients; Humanity – humanity is about why we are here – patients – tell your doctor why you need his or her help – why is it important that you lose weight or beat cancer? If your doctor understands why, you might have a better outcome. And most of all – mutual respect – so many of us give every living breathing moment of our existence to caring for you – if things don't go as planned 100% of the time, at least respect the fact that we brought our best of intentions to you today.