Why Doctors Hate Their Computers is the title of Neurosurgeon Atul Gawande’s recent column in the New Yorker. Having started with paper charts and adapting to multiple electronic health records or EHRs during my career, it’s a topic I relate to. As a multi-tasker I’m pretty comfortable simultaneously looking at my patient and typing. I’ve also experienced many iterations of trying to make EHR use more palatable for clinicians, including using medical student wannabes as scribes. However, I’d never heard of virtual scribes—physicians practicing in India who enter data for Massachusetts physicians. As scribes they are paid more than they get for seeing their own patients and it’s a learning opportunity, hence many are happy to engage. But as a physician who does global work, my stomach did flip-flops. Who’s benefiting and who is missing out? Is this another form of brain drain? Instead of “foreign” physicians coming to the US to practice, we are using them on their own turf. Who is providing care to their patients?

Dr. Gawande also drew parallels with the construction industry.His patient, a construction supervisor, witnessed Gawande’s struggle with the computer and empathized. “I have the same problem.” And he described how quality control software and time-lapse cameras on construction sites allowed for more precision, but demanded more data entry, generated more email alerts and complicated the process. “It eats up time. You end up on the phone, back to the old-school way. Because it’s a people business.”

Sound familiar? I wondered if the computer record burden was due to our capitalist system: In health care, competing EHRs are purchased by different health systems. Because tech companies compete and health systems compete, different EHRs often don’t talk with each other, or do so poorly. For example, in my most recent job I had to sign into another system to get the hospital discharge notes, causing me to go back and forth between two screens and sometimes print out the paper summary. In addition, medication information within the record about what a patient’s insurance covers isn’t dependable. Too often,if I follow the computer, I get a message later asking me to choose another prescription or complete prior authorization paperwork. Flipping between records and the prescribing activities add to what we call WAC—work after clinic. Would I face the same challenge as a Canadian or UK physician?

Yes! The EHR has been a mixed bag in Canada and the UK in spite of the single payer and national health insurance models. Both speak of benefits—opportunities for patient safety and better data, but report trouble with implementation, time challenges, lack of knowledgeable support personnel, and lack of interoperability with hospital and pharmacy systems, and physicians doing increasing amounts of administrative work. Everyone talks about increasing burnout related to these burdens. THE WAC eats into family time and personal time! Physician burnout is a hot topic and the American Academy of Family Physicians has created a tool kit!

So perhaps this is a societal problem. Reed tells me that 20 years ago in the bicycling industry an assistant managed department calendars,took minutes at meetings and sent out correspondence to clients. Now supervisors are expected to do it themselves.

Today technology consumes our lives, adding benefit and burden, and constant stimulus. Recently we spent the New Year in New York. Subway passengers sat focused on their phones. People walked down the street either talking or texting as well as studying the GPS map to figure out where they were heading.

I am worried about the millennials, but my millennial nephew-in-law told me he’s worried about the younger generation. During dinner after a soccer match, he sat at a table with the other coaches, assistants and parents, other millennials, who’d traveled to support the junior high team. Folks at his table were talking, having face to face conversations. But the table of players, eleven to thirteen year olds were all on their smart phones.

Is technology the new Godzilla? Maybe—international and national policy and employment status are now communicated by tweet. I am worried for all of us. No wonder yoga and mindfulness apps are so popular.

However, rarely is anything all good or all bad. But I believe that face-to-face communication and human interactions continue to be important, especially in health care. The doctor and patient interaction is especially critical. The sharing of the story and the holding of the story provide the milieu to understand what is going on and to chart the best way forward together. That is not something captured by check boxes and lists. In fact it is within the interaction that the healing occurs.