Same Shift, Different Day: Like Cats, ED Computers Are Moody… : Emergency Medicine News


EM technology, EM computers, EP life


My daughters were 13 and 9 years old when, in consultation with their mother, they decided that we needed a cat. As a child I never had a cat, I always had dogs. Cats are moody, aloof, unpredictable, and generally not dog-like.

Like the alpha male, take-charge-ER-doc guy that I am, I perform. We didn’t get a cat.

We have two. One for each. In my defense, I made it clear that I wouldn’t care about her. You should feed them, clean the litter box, and give them the attention they needed.

The children are now 25 and 22 and we are empty nests. Well not exactly. The cats are still there. The other day when I was cleaning the litter box, I thought, how did that happen? I clean up cat poop.

The answer is that it happened slowly. I collapsed. I have to admit they grew on me. I enjoy them and they give me positive feedback at times that I am told is the most powerful way to reinforce behavior. They come over to rub what I think I am delivering perfectly. Then, all of a sudden, claws, and I quickly go to school. I’m never sure what went wrong. Obviously I missed the memo about eye contact or something.

We actually had three cats. My wife rescued one from an animal shelter. I never really got the story of how she ended up at the shelter in the first place. It’s 15 miles away, not like a just random neighborhood deal.

Do you remember the litter box I swore I’d never clean? One of the cats decided she wasn’t going to use it at all. We found small gifts on the carpet. We tried to get everyone their own litter box. Did not help. We spoke to the vet. It turns out that cats are not pack animals like dogs. They are loners and like to be alone. We stressed our cats instead of creating the perfect little feline community.

Not papery

It was about 10 years ago when the government and administration decided that we needed an electronic patient record. I didn’t have an EHR as a new doctor or for the first 15 years of my career. I’ve always been a paper person. Computers are moody, unpredictable, sophisticated, and generally not paper-like. Since we were a group of independent Alpha ER Docs, we said we don’t need an EHR. Of course, we thought of patient care.

Similar to my cat protest, it didn’t matter; it was a closed deal. So we have a cat, I mean a computer. We said to IT, “You have to take care of it, wait and make it the way we need it.” They said, “Oh yeah, it will be exactly what you need.”

Then came the second cat. No more transcription service. This is too expensive. We got speech recognition software and said it would get along fine with our EHR. It would communicate with our computer and we could watch it type our notes word for word into the medical record. It would be a game made in heaven.

Our third “improvement” was the radiology software package. It turns out that while computers are better than cats, they aren’t pack animals either. They generally get along, but often don’t talk to each other or play nicely.

Sometimes one of them decides to take a break. It takes some downtime, you know, a fresh start. Unfortunately, nobody is asked when this Me-Time should take place. Often times, it occurs at the worst and busiest times in the emergency room. How about 6 p.m. on a Friday? Perfect, right after everyone has finished work and the doctor’s offices close. Not 3 a.m. on a Tuesday.

To the races

They also threaten you: “I will discard your work if you do not deregister.” I have no idea what mood they’ll be in after their nap. Sometimes I can’t tell if they achieved anything at all. Sometimes something is wrong with the look of my favorite order list. What is missing? I am sure this is not important; it will work by itself, and I’m sure it was worth interrupting patient care for this new font.

Sometimes they refuse to interact with each other at all. The x-ray was taken, but the image did not appear on the online screen or the report did not appear in the medical record. Randomly. When a cat decides to stop and lick itself, the voice microphone decides not to turn itself off. Or if I say a word that sounds like one in the preprogrammed text, whoa, then it goes.

I sign out, unplug, and put back in again. I’ll switch jobs and shut down or restart before giving up and filing a ticket. I asked my wife why she put my toothbrush glass off the bathroom counter on a shelf. “I caught the cat licking,” she said, “and I don’t think it’s the first time.”

Big. I’m not sure what the computer equivalent of licking my toothbrush is, but I’m sure it happens during our conversation and will be just as disturbing.

The other day I was under the desk trying to trace a cable back to its source. My mouse didn’t work. I thought how did that happen? I am a doctor under a desk fixing a computer. It’s the litter box I swore I wouldn’t clean. It doesn’t really stink that much, but it still stinks.

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Dr. Harmonis an emergency physician at the Marian Region Medical Center in Santa Maria, CA. Read his past columns below