The Heart of the Matter

A family physician reflects on his own experience with open-heart surgery and the process of care in a top-flight academic medical center.

I am running on a treadmill. Perhaps you are, too. Your treadmill may be meeting productivity goals for patient visits, building a successful academic career or balancing work and family. Mine is a real treadmill, the kind that gets faster and steeper every three minutes. read more…


“It seems that the patient, the document and the clinician are growing apart.”

“…Delegation is replacing integration in our patient histories, and format is winning over content in our records.”

“Physicians and nurses now touch the keyboard more than they touch the patient.”

“…The documentation imperative now drives the clinical encounter.”

“The map is not the territory and the medical record is not the patient, even when it is on a computer.”

“If communication, touch and healing are to be part of our “best practices,” then we need to continue the search for ways to make the patient the focus of patient-centered care.”

“As we move our practices to team-based care, we need to make sure the patient sees and feels that the care team is real and that the team really cares.”

“When we work in teams we must be sure that, along with efficiencies, come feelings.”

Read the essay

Please comment and share.

Copyright © 2013 W.R. Phillips
Originally published in:
Phillips WR. The Heart of the Matter. Washington Family Physician. 2013; 40(4):12-13.
Used with permission.

This entry was posted in Essays and tagged , , , , , . Bookmark the permalink.

3 Responses to The Heart of the Matter

  1. Wil Van Cleve MD MPH says:

    I’m a pediatrician who returned to residency for a subsequent training in anesthesia.

    My perspective on the care we deliver has broadened considerably as a result of this dual training, and I frequently joke with friends about my goal of being one of the world’s few “primary care anesthesiologists.”

    As both a doctor and a patient, I share your sense that we are losing the personal relationships that once formed the core of the therapeutic relationship we can offer patients. It seems to me a shame that we consider the loss of these relationships to be a necessary cost that permits the technological advances that made your surgery and recovery possible.

    I do not believe it has to be so, only that we are allowing it and failing to stand up and call out the things that matter.


  2. Eric Parsons, MD says:

    I find this spot on. I work hard to pass on to the medical students I mentor the meaning of personal relationships and demonstration of true caring with patients. However, I am constantly reminded that our energies and focus so often are directed toward checking the correct boxes and getting billing codes correctly entered. We teach how to do an effective oral presentation and SOAP note – but then generate ridiculously formatted EMR notes. I, too have experienced a team of care providers (whilst recovering from a kidney procedure with some complications) that I experienced in brief spurts, disjointed, not aware of each others plans and recommendations. I don’t understand how non-physicians can advocate well for their selves and loved ones when they are ill.


  3. Moyez Jiwa says:

    Wonderful post thank you. I had the privilege of being introduced to medicine by the late James McCormack at trinity college Dublin. His book ‘doctor father figure or plumber’ has rested on my book shelf ever since and reminds me why I chose general practice and not cardiology as a career. Your posts reminds me again. It is sad that our profession has been driven into bean counting. The job of the physician is to assist healing, not erect a temple to the god of technology. Wishing you a speedy recovery.


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