Like many clinics nationwide, my surgery office recently started using electronic medical records. Headaches and glitches abound, but over all, it has been a godsend: no more lost forms, deciphering lousy handwriting or waiting endlessly for someone to “pull the chart” if you want to look up a patient. Everything’s in one centralized computer system, accessible anywhere.
This brave new world, however, has created a singularly embarrassing moment at the end of all my new patient encounters. After saying hello, performing a history and physical examination, talking over the details of surgery and answering questions, I fire up the computer and start entering orders and preparing an after-visit summary for the patient to take home.Follow us at @ By WEN T. SHEN, M.D.
Here’s where it becomes awkward. I’ve just finished instilling in my patient a sense of confidence in my abilities, promising that my well-honed dexterity will result in the smoothest operation possible. I’ve outlined my surgical success rate over several years’ experience, assuring the patient that mine are hands to be trusted. Then I turn to the keyboard and start tripping over letters like a drunken giraffe.
I can’t type. My 1970s and ‘80s childhood was sandwiched between the typewriter and personal computer eras, and I never had any formal instruction in how to properly navigate a keyboard. I churned out papers in high school, college and medical school through the hunt-and-peck method, and things turned out just fine. A senior thesis, masters’ dissertation, a bunch of now long-forgotten articles in obscure surgical journals — all typed with my two index fingers, with recurring guest appearances by the right middle on the delete key. My 9-year-old son just started typing lessons in school and is already far more capable than I. His skill on the keyboard has resulted in much merriment at my expense (an increasingly common phenomenon these days).
I had always regarded my absence of typing skills as not much of a problem, part of the considerable dust pile of things I never learned how to do, alongside whistling and driving a stick shift. Until my surgery clinic went electronic. Not long after the transition, I began noticing distinct signs of discomfort from patients as I fumblingly clacked away: raised eyebrows, a shifting of weight in the chair, even some subtle throat-clearing. The thought bubble was pretty transparent: “This is the guy who’s going to cut me open and rearrange my insides?”
There are many ways I could circumvent this uncomfortable pause and maintain an image of precision and infallibility. Wait until after the patient leaves to start charting (impractical given our clinic workflow); hire a medical scribe to do my documentation for me, as detailed in a recent New York Times article (not happening with recent budget cuts); use the nifty speech-to-text dictation device provided to all clinicians (feels extremely weird and off-putting to do this in front of patients); actually learn to type (old dog/new tricks, dwindling brain plasticity).
Instead, I’ve chosen to meet the awkwardness head-on. I turn towards the patient and say: “Forgive my hunting and pecking, I never learned how to type. Don’t worry, I can operate just fine.”
It has become a funny, disarming moment in an otherwise usually serious encounter. Surgery consultations are rarely laugh-a-minute affairs as it is, and I’ve found that this little injection of levity helps mitigate some of the tension that can develop.
By admitting a little bit of vulnerability, I also show the patient that I’m human. Surgeons have traditionally been perceived as heroic, mythical figures who do great work in the O.R. but may not possess the best people skills. Typical surgeon communication of the past was gruff, paternalistic and authoritarian: my way or the highway.
As a profession, surgery is now trying to improve channels of communication with patients, encouraging two-way dialogues about treatment options, providing more time for questions or concerns, even making room for open displays of emotion such as joy and grief. Surgeons are still expected to convey a sense of confidence, skill and cool under pressure, but that doesn’t mean they need to spend all their time on a pedestal.
The brief moment when I acknowledge my fumbling typing skills has become a chance to show my patient that while I feel very comfortable in my surgical abilities, I am also well aware of my limitations. Suddenly, the pedestal is not so high. The aura of invincibility that has long shrouded the surgical profession, that can sometimes spill over into arrogance, coldness, and toxic relationships between surgeons and those around them, starts to melt away. Consider it my attempt at revamping stereotypes, two fingers at a time.