A laptop in my clinic

Our practice recently provided each of us with a laptop so we could begin e-prescribing. I was not a fan of this idea at the beginning as I had concerns that looking at the laptop would detract from important eye contact with the patient and minimize the importance of history taking.

I was completely wrong but not for the reasons I had imagined.

Firstly e-prescribing works and works well.

More importantly I have found that the ready access to important, patient-friendly information is invaluable when trying to explain management issues that require direct patient involvement in their care.

Type “oral glucose tolerance test” into the Google search engine, click on images, and the patient can learn firsthand the difference in glycemic control between non-diabetes and diabetes. They quickly recognize that not only is the fasting glucose level higher in diabetes but that the increment in blood glucose is very much higher after the oral glucose load. That does not come as too much of a surprise to many of them. What does get their full attention is that the glucose level is back to baseline within one to two hours in non-diabetics but stays markedly elevated for several hours in patients with diabetes. This is well known to you but comes as a surprise to patients and helps get my message across about checking post-prandial glucose as they attempt diet modification. Sure, I could simply print the image and paste it on the wall in the clinic but there seems to be something different about finding this information in the public domain on the Internet — it’s not just “doctor speak.”

Another use for the laptop is the graphs of serial patient data that I can pull up on the screen. Learning that the HbA1c has gone from 7.2% to 7.6% gives a message to the patient but not nearly as dramatically as being able to show them graphically the progressive increase in HbA1c over a period of one or two years. The same is true for all serial data be it the lipid profile, eGFR, etc. The system works just as well, perhaps even better, when you can demonstrate progressive improvement which is of course the ultimate goal.

I also find it useful when directing someone to online information from a patient-oriented website I have reviewed. The opportunity to compare that to the websites they have been accessing without any filter as to what may or may not be scientifically correct is generally well received.

We have all experienced the plethora of unfiltered material patients are bringing to their clinic visits. Most of them are extensively marked up to make certain that we get to each of their issues. Turning aside their homework is disrespectful and rude. Offering alternatives so that they can be more focused about the information they review is a more polite way of engaging the patient interested in taking care of their health issues.

Peering at a laptop screen together has not distanced me from my patients but has actually brought us closer together both literally and figuratively.