How Have Computers Changed Provider-Patient Relationships?

Bob Wachter, MD; Professor and Associate Chairman, Department of Medicine, University of California, San Francisco

Computers are changing the doctor-patient relationship in all sorts of ways. Some of them are really healthy; some of them are quite scary.

Let’s start with the scary part. You go and see a doctor today, there’s a decent chance the doctor will say, “And tell me, what’s the problem today?” And as soon as you start speaking, the doctor will have his or her head down, in the laptop, or on the computer typing the note, and patients have gotten the impression that the doctor is paying more attention to the digital version of them than the real version of them.

And one of the interesting manifestations of that is, the fastest-growing profession in medicine today is young people being hired to feed the computer (called scribes), which I find a remarkable workaround because in every other industry, when they digitize, they lay off half the people. Only in medicine could we figure out a way of adding new bodies. But we have.

So, the degree to which the computer has, in some ways, inserted itself between doctor and patient in the relationship, I think is concerning, and we’ve got to figure out a way around it. And some of that’s going to be technological — voice recognition — but other parts of it are just going to reimagining the doctor-patient visit.

The good part, I think, is the democratization of health care. I think the idea that the doctor is up on the pedestal and the patient is down here, and the doctor is the font of all knowledge, creates a level of paternalism that’s unhealthy. And a level of disengagement on the part of the patient that’s unhealthy.

And, so, what the computers have done is democratize health care and all sorts of ways. In many ways — similar to other industries, you know — patients now have access to a huge amount of information. In fact, in some cases, [they] know more about things than the doctor does. There are online communities where patients are learning from their peers. I think that’s fabulous. Patients now have the ability in some circumstances to read the doctor’s note, to email their Doctor, to get care through telemedicine.

I think we’re working out all the details there, because you’ve really kind of changed the workflow and the nature of the relationship. But, on the whole, I think that’s extraordinarily healthy, and really quite exciting.