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Month: August 2020

Letters of Expeditions

It seems that there is a resurgence of old as a countermovement to the unrelenting progress of technology. While it may connect us more quickly and efficiently than anything prior, the pace has become exhausting. Hours of Zoom calls and conferencing can help relieve the lack of social contact, but also contribute to “Zoom fatigue.”

People want a break. Salama argues that writing letters might be a fun way to do so.

After many days of nonstop Zoom calls for work, the last thing he wanted to do was look at another screen to catch up. Plus, he said, writing a letter could be a fun creative exercise to break up the monotony.

So I wrote back. And then I wrote to another friend and another, and lately not a week has gone by when there hasn’t been a letter to respond to. In most of these exchanges, there seems to exist this unspoken code of slightly formal, performative language meant to evoke the past. My childhood friend’s first message, for instance, included a florid analysis of John Keats’s maritime isolation off the coast of typhus-plagued Naples in 1820.

“There’s something about the ambience of the room,” he wrote. “The gentle fire, the nautical aura, the fact that I’m writing a note — it makes me feel like a captain off on an expedition in a foreign land, writing back home.”

It adds to a sense of emotion and escape, yet hardly detracts from the ability to write candidly about our wide range of current experiences.

[. . .]

But like so many other things in this otherwise-terrifying global quarantine, I’ve found writing letters to be wonderful in the simplest of ways. For each one, I sit at our dining room table for the better part of an hour, away from my phone and computer, with only a sheet or two of blank white printer paper in front of me. I’m hardly able to keep a regular journal without it feeling like a chore, but writing to someone else is sending a fresh entry off into the world without ever having to look at it again.

In return, I’ll be left with something far more interesting than a mundane account of my own pandemic days: a patchwork of pages that were sent to me by others, each one fresher than the next.

It’s been deeply comforting to think that whatever I am writing will soon be in the hands of someone else, especially in a time of so much physical distancing. I’ve sent letters as far as Argentina and South Korea, and as near as only a few blocks from my door. Some of the handwriting I’ve seen, like mine, has been laughably illegible; other letters are aesthetically works of art. One friend, an international student isolating on an otherwise-emptied college campus in New Jersey, enclosed a petal from a blossoming cherry tree. In these pages, I read the smiles I cannot see.

Jordan Salama

The romantic idea of the adventures of expedition continues to be something that we dream about. Those with actual experience used to write their “purple prose” in journals and memoirs. Today, these escapades tend to be documented with video—the likes of vlogs and documentaries. Instead of being privy to the minds of the writer and the emotions they experienced, we observe the situation directly. In some ways, this is limiting. We are neither physically present to have the full depth of experience, nor are we able to understand the emotion that the adventurer feels. We are just observers.

Even in scientific writing, where objective observation is still key, when recounting the scientific writings in libraries around the world, we harken back to a day when that observation required some amount of interpretation. We knew that everything was seen through the lens of another person rather than the sterile lens of a camera. Yet, the act of interpretation is now invisible, but very much still there. Instead, the charge now lies solely on the viewer, which leaves it exposed to an unprecedented vastness of minds.

Certainly, in many ways this can be a positive. But we have learned that it can also be a negative. Gatekeepers exist for a reason, and the harsh reality is that we now understand that they do provide some value, i.e. that of expert interpretation to help us recognize and understand the key details amidst a forest of trees.

Cameras for example, have revolutionized science for the better. However, we prize them too much, forgetting that even they are not as objective as we might initially expect (think, aliasing, for example). Partly for this reason I enjoy the cinema—people know that it’s a heightened experience, better than reality. Yet we still have the ability for it to feel very real.

Ultimately, writing letters to one another reminds us of an another age. One where people might have been more connected than we are today, as counterintuitive as that seems.

Dossier

“You Should Start Writing Letters,” by Jordan Salama, July 12, 2020. https://www.nytimes.com/2020/07/12/opinion/letter-writing-coronavirus.html

“When the World Stops, Traveling in John Keats’s ‘Realms of Gold,’” by Frances Mayes, March 26, 2020. https://www.nytimes.com/2020/03/26/travel/coronavirus-essay-mayes-keats.html

“How Whole Foods, yoga, and NPR became the hallmarks of the modern elite,” by Ezra Klein, November 14, 2019. https://www.vox.com/podcasts/2019/11/14/20964420/whole-foods-yoga-npr-elite-ezra-klein-elizabeth-currid-halkett-inequality

Is Reading A Chore?

When you read, your brain does much more than simply comprehend the words in front of you: It enables you to empathize with people you’ve never met, to engage with ideas that challenge and inspire you, to imagine other worlds.

Emily Underwood

The world of literature is unparalleled in its ability to transport us to an imagined dimension. That feeling of anticipation for the next page, with a tinge of bitterness as the book nears its end, is more than just entertainment. It is a cultural statement that enables society to explore its deeper meaning in the context of the vast array of people that make it up. Reading a culture’s literary achievements shines light on an otherwise deep abyss that resides within the collective minds of people, nigh impenetrable with other means.

Certainly books and novels are the most obvious examples, but this world of literature is not necessarily limited to them. I think that music, poetry, and even non-fiction news and articles, all belong to such canon. One medium that I am particularly fond of is film. I absolutely love the blend of the technical disciplines and the creative arts. It’s also not a solitary art, but rather requires collaboration.

As todays world moves further towards the real of interactive media, fewer and fewer people read. I think that this phenomenon is partly because we rarely experience “the pleasure of immersive reading — the feeling of losing [ourself] in a book.” We skim and skip, which leads to us forgetting what we’ve read, sometimes only moments later.

Over the years I have read a lot of material; and forgotten even more of it. Certainly for the most interesting reads, I can discuss the salient points⁠, but the minutiae?⁠ Not really. So is there some redemption; some way to get back the ability to read effectively?

Emily Underwood argues that there are “no hacks or shortcuts to reading at this deep level.” It simply comes down to eliminating distractions and actively reading the text.

Active reading — taking notes, sketching, and talking with a friend about the text — can also help forge mental connections between the information you’re taking in and what you already know, increasing your retention.

Emily Underwood

A simpler method, when you just want to save an inspirational highlight, is to use a resonance calendar, which I first learned about from Ali Abdaal’s video.

I played around with idea of a resonance calendar myself in late 2019. But this was before I started writing frequently. And now, I’ve found that this process⁠—writing down my thoughts and composing them for others to read⁠—is actually far more effective way to remember salient points. As I’ve argued in the past, it is the development of ideas and the thoughtfulness that facilitates the act of remembering.

In the past, I might have read something and thought to myself, “Wow, that’s cool!” only to promptly forget it the next day. Now I actually write down my thoughts, distill them into their core idea, and synthesize them on the page. In reality, this blog is now my resonance calendar.

Wolf adds: ‘The good reader . . . goes beyond knowledge, goes beyond emotions and perspective-taking, into a realm where the furthest reaches of our thoughts can be generated.’ The ultimate goal of reading shouldn’t just be memorization, but reflection and insight.

Emily Underwood

Dossier

“How to Remember More of What You Read,” by Emily Underwood, January 22, 2020. https://forge.medium.com/how-to-remember-more-of-what-you-read-135022bf7668

“How I remember what I read,” by Ali Abdaal, July 28, 2019. http://email.aliabdaal.com/issues/how-i-remember-what-i-read-190611

“How I use Notion as a Resonance Calendar,” by Ali Abdaal, October 19, 2019. https://www.youtube.com/watch?v=lKYBB-Uw1IM

“Atomic Habits,” by James Clear, October 16, 2018.

The Medical School Personal Statement as a Genre

Note: This analysis was originally written for the Teaching Writing course (WR 3011) at Worcester Polytechnic Institute by Sahil Nawab and Enyonam Edoh and is reproduced here with permission.

Introduction and Defining Features

The personal statement, as used for U.S. allopathic medical school applications, is a genre that is not well studied in the writing literature despite its similarities with other graduate or professional program applications. While there are many facets to the medical school application, including other components such as GPA, MCAT score, extracurriculars, letters of recommendation, the personal statement critically serves to tie together these other elements and anchor the application with a narrative about the applicant’s personality.

Medical schools expect an answer that highlights the unique qualities of an applicant and simultaneously describe their journey towards deciding to pursue medicine. Applicants often use the personal statement to communicate more broadly about themselves and their own personality. This paper serves to analyze this self-promotional genre by analyzing the defining features, discourse community, rhetorical moves, and dichotomy to provide an outlook of what this genre is and what it’s turning into in the near future.

The personal statement includes the following prompt, “Use the space provided to explain why you want to go to medical school,” which must be answered using a maximum of 5,300 characters. The defining feature of the personal statement prompt is it’s intentional vagueness. The Association of American Medical Colleges (AAMC) describes the personal statement as “an opportunity to distinguish yourself from other applicants” (2020 AMCAS Applicant Guide). Despite the open ended prompt, the personal statement is commonly expected to answer the questions, “Why medicine?” (Advisor Corner), “What motivates you to learn more about medicine?” (2020 AMCAS Applicant Guide), and “What do you want medical schools to know about you that hasn’t been disclosed in other sections of the application?” (2020 AMCAS Applicant Guide 54). Within this limited space, applicants often struggle to effectively articulate their undergraduate and preclinical experiences through a narrative that is engaging to the admissions committees of medical schools.

Unique to professional programs like law and medicine, applicants for medical school can come with degrees from fields completely unrelated to the professional practice of medicine. Because of the diversity in the experiences of medical school applicants, the lack of prescriptive guidelines is useful. However, it presents its own set of challenges, as applicants are often confused about appropriate writing practices in the personal statement and unfamiliar with the conventions of the genre (Advisor Corner and Ding). Requiring applicants from other fields to justify their decision to study that field and to “justify their motivation to shift from their previous areas of study” inherently creates conflict. Applicants must show that not only were they were dedicated to their previous area of study, but are now ready to move on to study medicine and are just as dedicated, if not more.

While the flexibility that such a vague prompt affords is helpful for such applicants, that the personal statement is “something between a reflective, analytical narrative, and an argumentative essay” (Advisor Corner) causes issues with balancing the sometimes conflicting nature of these elements. In essence, however, the personal statement serves two purposes: revealing “something about yourself and your thoughts around future in medicine while also making an argument that provides evidence supporting your readiness for your future career” (Advisor Corner).

The 5,300 character limit, as prescribed by the AMCAS requirements (2020 AMCAS Applicant Guide 54), showcases an implicit value in clear and concise argumentation. Part of the exercise in writing a personal statement is learning to distill entire experiences into words, present goals, motivations, sincerity, and likeable personality. The narrative must “capture the reader’s attention,” “establish the writer’s competence,” and “demonstrate the fit between the writer and the field of medicine” (Ding 371). “Applicants have to establish their academic and professional qualifications, demonstrate their abilities through work experiences, discuss their interests and motivation in studying in the target field, explain why the target program matches well with their interests and goals and what contributions they can make to the field; and explain their future study and career plan” (Ding 371). Most students struggle with this self-promotional aspect of the genre, especially when caught up in creating an effective narrative and fail to recognize that the personal statement is not listing accomplishments or restating a resume in narrative form (Jacoby). Rather, the narrative is purely in service of communicating “fit” to the audience. Therefore, a deft understanding of the discourse community benefits applicants writing personal statements.

Discourse Community

The discourse community in which the personal statement operates within consists of two primary parties, the applicant and the admissions committee. While the specific makeup of the admissions committee varies widely from school to school, it generally includes faculty, physicians, and privileged medical students. The admissions committee uses the personal statement to gauge the applicant and determine whether or not the applicant’s thought process is consistent with that of a physician.

The evaluative nature of this relationship results in a power imbalance between applicants and the admissions committee. Applicants actively require the approval of the admission committee to matriculate into medical school. However, it is the medical school experience itself that is designed to sculpt a student into a physician and thereby imbue them with the qualities expected by the discourse community. Lacking this prerequisite experience, applicants are therefore unfamiliar with the expectations of the discourse community and often have difficulty writing a personal statement that reflects the expectations.

Rhetorical Moves 

Despite the inherent challenges with writing an unfamiliar genre and the large diversity of medical school applicants, successful personal statements have a surprising amount of similarity. Ding’s analysis showed that there are five recurring rhetorical moves associated with the personal statement that applicants often use to connect their personal narrative back to the primary question of why applicants choose to pursue medicine.

Move 1: Explaining the reason to pursue the proposed study (i.e. why medicine?)

Move 2: Establishing credentials related to the field (i.e. clinical/research experiences)

Move 3: Discussing relevant life experience

Move 4: Describing personality

Move 5: Stating Future Goals

Through her analysis, Ding found that the first move requires three distinct steps. In the first step, the applicant wants to explain the academic or intellectual interest in medicine by telling the way that it came about through an experience In the second step, applicants state their understanding of the profession based on their experiences to show that their understanding helped then make the decision to study medicine. Elizabeth Jacoby, a pre-med advisor at Worcester Polytechnic Institute, argues that the third step must be done skillfully it is easy for a writer to harbor on personal and family related experiences that deviate from the purpose to pursue medicine. Ding and Jacoby agree it is best to acutely focus on how these led up to the decision to “Why medicine?”

Examples of Moves 1 and 4

“I aspire to be a physician because I want the long nights, tough choices, and to serve patients. I value the opportunity to be a part of, and lead a team entrusted with the lives of others. I want to advocate for my patients, work for better health, and heal. Working for, and with physicians has allowed me the…” (2)

“My desire to enter the medical field is intertwined with my passion for singing and performing. I believe that my career as a physician, like my work as a musician, will give me the opportunity to improve the lives of my patients, but more directly, more completely. My experience volunteering and performing has shown me the value of working with underserved populations. Singing around the world has taught me, in a small way, how to communicate with audiences, regardless of their backgrounds. I will use what I have learned performing to connect with my patients and I look forward to working with people from all walks of life on a daily basis” (2).

Move 2 requires the applicant to communicate their credentials related to the field of medicine. Ding explains to be the most important move in the personal statement. It is also done can be seen in 3 steps or ways: a list of academic achievements, reviewing research experiences, and discuss suing professional experiences in clinical settings. It’s important to know why Ding, Jacoby, and Faber agree that credentials are important in this field but it is important to not just list them but to explain how this all relates back to why one wants to pursue medicine. It is important to talk about the experience.

Examples of Move 2

“… while climbing the concrete steps, and he smashed his knee and elbow in the process. As a newly certified EMT, it was the first time I was responsible for another’s health. Though numerous EMTs stood throughout the room acting as both a source of evaluation and a safety net, he was my patient” (2)

“Almost a year later, I visited Haiti with Project Medishare hoping to help individuals with lesser access to healthcare. One night we were working to resuscitate a lifeless, premature newborn boy. Despite the baby regaining circulation, we were without a ventilator with settings for a preemie. We quickly exhausted alternatives and were left using meager resources to create a way to deliver continuous oxygen to the baby. When even this failed, we were out of…” (2)

“… benefits to the patients. I have also taken Health Psychology and Medicine and Society. These classes have helped me to better understand the relationship between mental health and physical health as well as social condition and the health care system” (2).

Move 3 is related to move 2, but deals more specifically with experiences that showcase personal growth or resilience in the face of adversity. Not every applicant can have the same opportunities to gain professional opportunities to do volunteering and shadowing. Many use non-clinical community settings and their people skills to show their willingness to help people.

Examples of Move 3

“… year, I volunteer each week at MobileMed, a mobile clinic for the uninsured individuals of Maryland” (2).

“But what does this have to do with medicine? A singer, after all, heals with melodies, not antibiotics or operations. Yet it was my singing that first sparked my interest in medicine. And after a decade of seeing my voice bring some small measure of joy or peace to so many members of my audiences, I need more. I want to continue to bring joy and peace. I will continue to sing, but I want to prevent those around me from becoming infirm and forgotten in the first place. I want to be a doctor” (2).

Move 4 requires describing the applicant’s personality. Most guides describe that this needs to be shown through a recollection of their experiences. This is critical because this underlying unique feature is used to distinguish the applicant from the large application pool. Various medical school advisors share different ways of doing this. The University of Oxford, stresses that applicants demonstrate their personality traits through anecdotes, rather than explicitly stating them.

Move 5 is where an applicants states their future career goals after graduation, which stresses the goal-oriented nature and strong motivation of the applicant. It shows that the applicant is always thinking ahead and has a clear vision, therefore the applicant is prepared for the arduous journey ahead.

Examples of Move 5

“I believe that what I have learned from the many people and experiences over the years will help me to become a successful physician – sensitive to my patients needs and aware of my responsibilities to science, society, and the health care system” (2).

“However medicine is also a deeply gratifying and fascinating career path. I want to be a medic because my passion and aptitude is foremost scientific and to me 5 or 6 years more of formal education followed by a lifetime of further learning sounds like a stimulating career option and, thankfully, a far cry from the monotony some jobs pose. Nevertheless, as an intrinsically social person, I would relish a career requiring the development of strong empathetic relationships with patients too. Crucially, I know that I have the enthusiasm, capacity for hard work and the open and enquiring mind needed to succeed in such a fulfilling vocation” (2).

“Outside of my lessons I enjoy orienteering with a local club. As part of an expedition I took part in, we walked 80km over 4 days in torrential rain. The challenging conditions demanded teamwork and trust to maintain morale and perform effectively as a group; as well as calm rational thought in stressful situations. Also, through this activity and the people I met, I have become a member of the SJA which has enabled me to gain first aid qualifications and go out on duties” (2).

Dichotomy

Brenton Faber, a professor of writing at Worcester Polytechnic Institute and an active nationally-certified paramedic, provided some key insights into his perspective of the personal statement. He explained that the personal statement is not supposed to be as “personal” as it may initially sound. Rather, a successful personal statement, he argued, should show that the applicant thinks and reacts like a prospective physician-scientist. The “personal” information serves to create a narrative scaffolding that demonstrates the thought process and keeps the reader engaged.

An example Faber described highlighted this: if the premise of a personal statement is the writer’s reaction to a close friend saying that their mother recently had a stroke, then the personal statement should not begin with the response being, “Oh, that’s so terrible. How is she doing now?” but instead focus on “What type of stroke was it? Where was the occlusion? Was she on angiotensins?” and so on. Medical schools, and their admissions committees are looking for prospective applicants to embody the physicians’ professional gaze. The personal statement is meant to demonstrate that “when faced with an experience, you react like a physician” (Faber).

Faber’s perception was heavily based on Brown’s research into clinical psychology personal statements for MD/PhD programs. Brown argues that the key to a successful personal statement is that of a deep understanding of the audience. In particular, clinical psychologists are constantly reminded of the status of psychology as an “in-between” science; it’s not really a full science like biology, but not really an art either, some might argue. Therefore, psychology PhD programs are looking for applicants who take the scientific elements of clinical psychology seriously. Therefore admissions committees want the personal statement to reflect the applicant’s scientific rigor. While Brown’s argument is very specific to the clinical psychology program, the general medical school application is not all that different.

However, a dichotomy exists between this perspective, embodied by Faber and Brown, and the more recent approaches, embodied by Jacoby and many of the advising sites available to applicants (Kowarski). We hypothesize that the difference is a result of the movement of ideals in medicine and a shift in society at large towards a more humanist approach, including showing greater empathy and awareness of patients’ emotions. Therefore, medical schools may look for applicants that embody these traits.

For example, many advising sources (Jacoby and Kowarski) explain that the personal statement should contain a strong theme and narrative that demonstrates authenticity and resilience through the experiences of the applicant. She recommended that applicants examine their motivations and desires to go to medical school and explain how the applicant’s experiences led them to believe that. This focus in developing a deeply personal and introspective narrative that delves into the character development of an individual applicant stands in stark contrast to the more scientific approach championed by Faber and Brown.

Despite this dichotomy, every source agreed that understanding the audience (i.e. admissions committees) and their goals is critical to developing a successful personal statement. Sources also agreed that the personal statement should use the experiences of the applicant to demonstrate relevant characteristics, whether physician-scientist or humanist, rather than telling the reader that the applicant has these characteristics. However, the dichotomy points to greater need to understand the current audience, including medical school admissions committees so that applicants can better target their rhetorical devices to greater impact.

Advice and Conclusion

As a tutor to an applicant, the best method to provide an improved understanding of the genre is to provide examples of personal statements that worked well. This directly addresses a key issue limiting students: their unfamiliarity with the genre. A key to writing effective personal statements is to have a central theme to connect all of the applicant’s experiences and push the message.

An in-depth understanding of the discourse community and its goals is critical to developing effective personal statements, though this is difficult for applicants to achieve in practice as “outsiders” to this community. Understanding who the audience is, namely the admissions committee, their rhetorical background, and the purposes that the personal statement fulfills, allows applicants to better engage the reader as active members of the discourse community. Therefore, studying the personal statement as a genre of writing provides insight into techniques and methods that allow applicants to more effectively develop a cohesive narrative structure that, in turn, still serves the underlying purpose of communicating the applicants personal motivations and qualifying experiences.

Dossier

“2 Med School Essays That Admissions Officers Loved.” U.S. News & World Report, U.S. News & World Report, www.usnews.com/education/best-graduate-schools/top-medical-schools/articles/2017-06-12/2-medical-school-essays-that-admissions-officers-loved.

2020 AMCAS Applicant Guide. 2020 AMCAS Applicant Guide, Association of American Medical Colleges, 2019.

“Advisor Corner: Crafting Your Personal Statement .” AAMC, students-residents.aamc.org/choosing-medical-career/article/advisor-corner-crafting-your-personal-statement/.

Brown, Robert M. “Self-Composed.” Written Communication, vol. 21, no. 3, 1 July 2004, pp. 242–260., doi:10.1177/0741088304264338.

Ding, Huiling. “Genre Analysis of Personal Statements: Analysis of Moves in Application Essays to Medical and Dental Schools.” English for Specific Purposes, vol. 26, no. 3, 30 Jan. 2007, pp. 368–392., doi:10.1016/j.esp.2006.09.004.

Faber, Brenton. Personal interview. 1 Oct. 2019.

Ferguson, Eamonn, David James, and Laura Madeley. “Factors associated with success in medical school: systematic review of the literature.” Bmj 324.7343 (2002): 952-957.

Jacoby, Elizabeth. Personal interview. 1 Oct. 2019.

Kowarski, Ilana. “2 Med School Essays That Admissions Officers Loved.” U.S. News & World Report, U.S. News & World Report, 12 June 2017, https://www.usnews.com/education/best-graduate-schools/top-medical-schools/articles/2017-06-12/2-medical-school-essays-that-admissions-officers-loved.

Max, Bryan A., et al. “Have personal statements become impersonal? An evaluation of personal statements in anesthesiology residency applications.” Journal of clinical anesthesia 22.5 (2010): 346-351.
Writing Guidelines: Medical School Personal Statements. Writing Guidelines: Medical School Personal Statements, Ohio Wesleyan University Writing Center, 2011.

The General Population

It’s interesting to note that when I write, my inclinations are to use scientific principles and logic to make an argument. However, from my work with the Worcester Free Clinic Coalition, I’ve learned that this technique doesn’t always work. I’ve recognized the need to carefully understand your audience, who they are, what knowledge they will come with, and never write for the “general population.”

One piece of advice that I learned from my rhetoric classes is this: when you define your audience as the general public, your audience is actually you. There is no such thing as a true “general public” and so when we think this way, we are actually imagining others through our own lens. Rather, we should carefully consider the audience and stay away from thinking that a piece is written for the “general public.”

One of the most important considerations in writing is the emotional context. As humans, we are not nearly as rational as we would like to think.

Thoughts on Electronic Medical Records

I have a deeply ambivalent relationship with electronic medical records systems, or EMRs. Initially, like many young people, I was completely on board with the transition to paperless and the efficiencies that come with it. However, my stance has changed during the course of my work at the free clinics in Worcester.

A lot of the clerical volunteers are older folk—people who are quite skeptical of technology. The physicians, too, are hesitant to embrace EMRs in the free clinics because of their constant struggles with the systems in their day jobs. In his well thought out and in-depth article, Dr. Atul Gawande describes the dangers and pitfalls of EMRs. Specifically, he mentions how EMRs are in fact a big contributor to physician burnout as a result of excessive record keeping and administrative burden that falls on the shoulders of physicians.

The physicians at the free clinics explain that the biggest reason why they enjoy volunteering is that they can practice true medicine without being encumbered by the unnecessary complexity of EMRs. Instead of staring at their screen trying to document patient encounters writhing the 15-20 minute time slot allotted, physicians can be more present with the patient, carefully listening to their story. This personal touch is why many doctors decided to pursue medicine in the first place, and EMRs should not take that away.

This is one big benefit of the free clinics, that doctors can devote their full time to listening to patients, answering their questions, and understanding their situation. They have a piece of paper in front of them rather than a screen and keyboard. They enjoy the freedom of being unshackled from their computers and electronic medical records systems.

Yet, all of these physicians also recognize the immense benefits that EMRs provide. Being able to quickly look up past patient records, even from different providers is incredibly useful. Automatic prompts that remind physicians to ask questions if a patient is at-risk can catch some maladies that might easily go overlooked without such systems in place.

Communication in medicine is critical to patient care. In fact, one of my past projects was to design a mobile application, quite akin to a pared-down EMR, for the labor and delivery ward to make patient handoff between providers easier and less prone to user error. A big challenge that we faced was ensure in that the system does not get in the way of patient care. We knew that often, software causes more problems than it solves, even if well-intentioned. So we put a lot of effort in observing the workflow of physicians and nurses to see where we can make a difference and where we need to make adjustments once our software was put in place.

There are times when there is utility for EMRs, even at the free clinics. For example, EMRs can be used to collaborate between clinics where patients may not be able to return to the same location or time due to transportation issues or scheduling issues, allowing them to easily come in where is most convenient. This alone would be immensely beneficial to patients, especially when the patient population is prone to not following up. Even just pulling charts from the filing cabinets, because sometimes they get lost, or are filed in the wrong area, or a patient used a different name. Having an EMR would probably alleviate 99% of all of those problems and save countless hours of work. However, careful, diligent testing and making sure that the EMR actually is is solving the problem rather than creating more problems is absolutely necessary.

And so there’s this dichotomy of whether we should actually use any EMR system or not. I really don’t know what the right answer is. I think both have their pros and cons and I think there should be more debate. I love the fact that Epworth is doing a pilot study to figure out the best way to implement an EMR system. 

My mother, a primary care physician, comes home every day with a multitude of notes left over to finish. She wants to spend more time with her patients, and I talked to her about this because user experience design and software development is an area that I’m interested in (particularly after my time working in the labor and delivery ward) and so I knew a bit about what goes into an EMR system. She told me how she doesn’t even bring her computer in, instead choosing to just bring a clipboard and some paper so that she can be fully present with the patient. There’s a computer in the room, but she only uses it if she needs to look up something that she didn’t jot down before entering.

And when I talk to the doctors and volunteers at the free clinics, where they still use paper, they consistently tell me how refreshing it is to go back to the original practice of medicine where EMRs aren’t getting in the way. I worked as a chart puller when I started volunteering, and still do when when the clinic is packed, and that’s when I think to myself, “maybe an EMR wouldn’t be so bad—I wouldn’t have to do all of this running around to find a specific chart.” But every time, I quickly realize that it would just cause even more problems with burnout and the volunteers likely wouldn’t want to come in. Patients would lose out on the personal connection with the physicians that the free clinics are able to provide.

This is ultimately why I think that EMRs, and specifically human computer interaction, is becoming a big problem in medicine. It’s contributing to physician burnout, worse patient outcomes. Importantly, though, it’s also a problem that we can reasonable work towards a solution and eventually solve. There are so many benefits to EMRs, but we should make them work for doctors, not the other way around.

Dossier

“Why Doctors Hate Their Computers,” by Atul Gawande, November 5, 2018. https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers

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