and time of arrival .”
“ We are 25 minutes out and the patient is in ventricular tachycardia at a rate of 180 / minute . His blood pressure is 90 / 40 and his oxygen saturation is 95 percent . We don ’ t need to shock him . We have started IV Amiodarone .”
“ Is he responsive ?” “ Not really , other than to say , ‘ I feel horrible ,’ over and over .”
“ Does he have any ID ? A name tag on his racing vest ? Anything to tell us his name or the city where he lives ?”
“ Yes , his name is Ben Smith and he lives in Indianapolis , Ind .”
“ OK , we will use the EHR system and see if we can locate any information on him .”
“ Dr . Jones , we have located Ben Smith ’ s records at University Hospital in Indianapolis . He is a surgery resident and has a history of concealed WPW syndrome .”
“ Ambulance One , how far out are you now ?”
“ Still 20 minutes because the runner was at mile 21 when he dropped to his knees and almost passed out .”
“ Ambulance One , stop the Amiodarone immediately and bolus the patient with IV Pronestyl and start a drip . We will be ready when you arrive .”
“ Trauma Room 1 - we just pulled in .” “ Take Mr . Smith to Trauma Room 1 .” “ Mr . Smith , you are sitting up and look fine .” “ I know , I think I converted coming into the hospital .”
“ Hook him up to an EKG .” “ He is back in sinus rhythm with a narrow QRS complex . He has a history of concealed WPW syndrome .”
“ Dr . Smith , we know you are a surgery resident in Indianapolis . When did you find out about your arrhythmia ?”
“ I was in high school running track , and every now and then my heart would race for a few minutes . I told my dad , a primary care doctor , and he sent me to a cardiologist who made me wear a 30-day event recorder . I will never forget ; I was on the 29th day thinking this recorder was such a waste of time when the arrhythmia started . At first they thought my diagnosis was ventricular tachycardia , but with the regular wide QRS complex and a normal EKG , they diagnosed me as concealed WPW syndrome . I only have these episodes once every three to five years and the episode usually lasts less than two minutes . I don ’ t remember anything earlier today , but I felt like I was going to pass out .”
“ Well , you are back in regular rhythm and we assumed you want to go back to Indianapolis to get your WPW ablated . We will send your EHR to University Hospital in Indianapolis . Do you need transportation now ? Who can we call to pick you up ?”
“ My parents are out of the country and I drove myself to the race because I am staying with my 93-year-old grandma .”
FEATURE
“ We will help you find a way back to your grandma ’ s house .”
“ Grandma , do not worry about anything . I am fine . I will back to your condo in a few minutes .”
“ Ben , I was so worried about you when the hospital called . But they told me you were fine - thanks to those fancy record things or whatever you call them .”
“ Grandma , I learned a valuable lesson today . You dislike Electronic Health Records because your doctor does not sit beside you . I dislike them because I spend too much time in front of a computer rather than in the operating room or with a patient . However , my own Electronic Health Records were vital to my treatment today . I was so weak I did not know what was going on and I could not even tell them about my arrhythmia . I was feeling worse in the ambulance , the hospital received my records from Indianapolis , changed my treatment and I stabilized quickly . Because of quick access to my EHR , I did not get shocked and my treatment was altered specific to my condition .”
“ I am so glad for you honey ; but I have one question before you head back home . How many patients like you are “ saved ” by Electronic Health Records versus how many patients like me lose a more intimate doctor-patient relationship because of Electronic Health Records ? Saving your life today is much more important to me than how a doctor interacts with your Grandma in the exam room ; however , most patients over the age of 50 will remember when they could talk to their doctor in confidence and with more intimacy than now .”
“ Yes , Grandma ; I remember I told you when I graduated from medical school a good 25-30 percent of the class became doctors with tremendous “ head knowledge ” to take care of their patients ; but those same individuals are not be able to relate to their patients personally because they are more interested in the science of medicine than the art of medicine . I promise you I will remember today for the rest of my life practicing medicine . I will never forget modernized EHR and other new modalities are responsible for bringing medicine into the 21st century ; however , I will remember the patient is still a human being with emotions , needs and concerns that no computer or no test can allay . Only a human touch or a time of intimate conversation can help many patients feel better about him or herself .”
David Dageforde , MD , is a retired interventional cardiologist with Norton CardioVascular Associates and now serves as Board Chair for the Shawnee Christian Healthcare Center .
NOVEMBER 2017 13