Why a Patient's Story Matters More Than a Computer Checklist

As I walk to the door of my patient's house on a dirt road outside Tuscaloosa, Ala., I step gingerly. Mrs. Edgars says that she killed a rattlesnake in her flower bed last year.

She is at the door, expecting my visit. Mr. Edgars sits on the couch, unable to recall that I am his doctor, or even that I am a doctor. But he is happy to see me nonetheless.

We chat a moment, then we move on to Mr. Edgars' arthritis. Early on in his dementia he wandered the woods. His wife was afraid he would get lost and die, although the family agreed that this was how he would want it.

Now his knee arthritis has worsened enough that it has curtailed his wanderings. I suspect that Mrs. Edgars is cutting back on his pain medicine to decrease the chance he'll wander off again.

We talk about how anxious he grows whenever she's out of his sight, and how one of his children comes to sit with him so that she can run errands. I leave carrying her parting gift, a jar of homegrown pickled okra.

Back at the office, I turn on the computer to write a note in the electronic health record, or EHR. In addition to recording the details of our visit, I must meet the new federal criteria for "meaningful use" that have been adopted by my office, with threats that I won't get paid for my work if I don't.

Under history, I enter "knee pain." Up pops a check-box menu: injury-related (surely the chronic wear on Mr. Edgars' knees as a farmer is an injury, but I don't think that's what the programmer had in mind); worsening factors (none apply, as he couldn't give his own history); relieving factors (there's no check box for a sleep-deprived wife who's purposely keeping the dose of acetaminophen low); and so on. Nothing fits, so I exit and type in "follow-up". It cedes a blank screen.