“Electronic records don’t tell us stories that make cognitive sense”
There’s an interesting post over at medpagetoday.com on the power of stories. Most of us don’t need to be reminded about the value of making endless details more palatable by putting them in a story form, but this is a terrific explanation as to how your best efforts fail if you don’t embed your evidence in a story.
Essentially, the physician writing the post talks about how the new electronic medical record relies on lists of symptoms and lists of history but makes it very difficult to get the “old-fashioned” story of why the patient is being seen currently and what the current symptoms are relative to his or her treatment. The post is written with evident frustration.
“One list will give us the medical history. In no particular order of priority, it includes one-word problems such as osteoarthritis or hypertension that have nothing to do with the patient’s current admission for acute pancreatitis. The relevant history of alcohol abuse may be found elsewhere, in the list under “social history”. The complaint of abdominal pain won’t be found anywhere near the list of laboratory values with the important amylase and lipase levels.
If you’re a consultant trying to make sense of the patient’s case, you can find yourself frustrated and stymied at the difficulty of getting the big picture. f you’re lucky, you can find a human who knows something about the patient, and get him or her to tell you the story.”
The post apparently struck a nerve with readers as there are multiple comments agreeing with the writer and only a few arguing this is the fault of the user as opposed to the program itself. Even the family members of patients are commenting about changes in the way they are viewed by treating physicians who have not been able to grasp the big picture due to the way the information is presented piecemeal and never summarized in one place.
It’s a good reminder of how jurors feel when not told a narrative version of the litigation “story”. Except jurors automatically “fill in the gaps” in ways that can be unpredictable. And then they become wed to their own version of the truth because filling in the gaps in the story is how they made it make sense.
Without their gap-filling, there was no story.
With their gap-filling, there is a story but it sure isn’t your story!
Avoid the danger of many electronic record systems. Tell the story to give jurors the big picture.