My Doctor and His COW
I’ll never forget the day my doctor had a COW.
It was four or five years ago. I was there for a routine check-up, and the nurse came in with one first. It was a tall wheeled table with a laptop computer on it: a Computer on Wheels. She took my vital signs and keyed them all into her COW. She also typed in my answers to her routine questions. Then she left, taking her COW with her.
There was nothing out of the ordinary about this. I thought it was long overdue, actually. Computers had become such a part of our lives that it seemed only right for the nurse to key in my information. But my doctor was the surprise.
You have to realize that I have a very down-to-earth physician. If he wasn’t a doctor, I think he’d be a carpenter or a mechanic. He’s quite knowledgeable, but he talks like a regular guy. Instead of spouting Latin medical terms, he speaks in plain English. “Don’t you feel that gunk at the back of your throat?” he asked me on one occasion. He doesn’t have the greatest bedside manner, but I’ve always liked his direct approach.
So on this occasion the door opened and in came my doctor, pushing this COW in front of him. He was not in a good mood. He sat down and started reading off questions. I answered them, and he typed in my answers, hunt-and-peck style. He made a mistake, swore, back-spaced, and typed again. I tried to tell him about a health issue that had come up and he barked at me, “Wait a minute. We haven’t come to that yet.” He asked me another question and wrote my answer. Then, with a sigh, he said, “Okay, now… what did you want to tell me?”
It was about my heart. I had always been in excellent health, but lately I had started feeling a slight flutter, and I didn’t know why. Normally, he would have been receptive to my problem, but on this particular day he just sighed. Paging down the app, he looked for an appropriate place to document my concern. More expletives followed. He asked me a few probing questions, typed a bit more, then applied his stethoscope to my chest and back. I don’t remember what came of it (I’m still alive), but I’ll never forget his response. He didn’t seem concerned about my health; he just seemed annoyed that I had asked him about something outside the script.
Then I made things worse: I told him about a mole that had lately grown on my neck. With an even bigger sigh, he stomped out of the examination room and came back a moment later with a tall, thin silver canister, which he pointed at my neck and sprayed at me without warning. The mole never had a chance. It was frozen instantly, and he told me it would fall off in a couple of weeks.
“Oh,” I said. “Um… okay.”
It was a very revealing visit. Generally speaking, doctors don’t relinquish control to anybody or anything. You rarely hear them saying, “Jesus take the wheel.” But on this occasion, the COW – or rather, some anonymous computer programmer – was running the show. My doctor had no choice in the matter, apparently. He was part of a local hospital network, and he was just one of countless physicians in our community who were linking up to the network. He was now forced to dispense with his routine and conduct the doctor-patient interview according to the script. He was clearly not happy about it.
But the story does have a happy ending. On my next visit, everything was changed. He had become accustomed to the new situation and was now using his COW quite naturally. He came through the door and shook my hand, smiling, just like he used to do in pre-COW days, then sat down at the computer and asked me the questions as if they were unscripted. My answers were promptly keyed in, without expletives, and interruptions were not only tolerated but welcomed, just as they had before the wheeled fiend had invaded our lives. The COW was not in charge after all; it was merely a tool that my doctor had somehow come to terms with and had successfully integrated into his routine. I was very interested in knowing how he had arrived at that stage, but I didn’t ask him. What mattered was that he had gotten there.
The COW really was overdue. It has made a big difference. I no longer have to decipher the doctor’s handwriting on prescriptions and other notes, because everything is typed. Medical terms are elaborated by the system, which adds a definition and examples. The results of blood tests are available online soon after I leave the office. And I know that, if I should end up in the emergency room for any reason, all my information will be available to the doctors and nurses there. It’s a much better system than we had before. Far from upstaging my doctor, the COW has made him even more valuable. But it took time for him to come to terms with the new system and integrate it into his routine.
I’m not advocating that we all bow down to the Golden COW. Far from it. At first, my doctor seems to have felt he was being asked to do that, and he hated it. But I’m celebrating the fact that my doctor, who is a good man with a lot of common sense, found it within himself to use the COW as a tool rather than to be used by it. And there’s a lesson there for all of us.