Communication in the era of COWs: technology and the physician-patient-parent relationship.

How did I find myself leading family-centered rounds a while ago in the NICU, yet unable to actually see any of my team members, not to mention my patient’s parents sitting just several feet away? I looked up while listening to a summary of the infant’s overnight events, and suddenly it hit me, something was amiss. My entire team was hidden, our views obstructed, from each other and the patient’s family. No one was fully focused or making eye contact during the presentation. I could not see to whom the presenting voice belonged. One resident was fixated on the computer screen, while another was obliviously typing away, nose to keyboard. This hardly looked the picture of family-centered rounding, or the epitome of good communication, things I strived for. The humbling culprit, aside from me? COWs. No, not the grass-eating, milk-producing kind of cow, but rather the portable data-crunching COW, affectionately short for “computer on wheels.” These mobile computing machines have now become permanent features of many hospitals and clinics, and for good reason. COWs help streamline and improve medical care, including electronic patient charting and documentation, increasingly onerous tasks. They allow physicians to, for example, quickly check on a laboratory result or write an admission note, while watching over a critical patient. COWs also help expedite clinic notes during back-to-back patient encounters. The COW certainly facilitates on-the-go charting, the new fast food of medical documentation for the multitasking physician. But, as I struggled with my own unwieldy machine during rounds, trying to find the optimal positioning for the albatross, I realized that COWs may also sometimes hinder effective communication and, thus, patient care. Good communication is, of course, extremely important in medicine. It is the foundation of any successful physician–patient–parent relationship in pediatrics. A key component of effective communication with patients and their families involves active listening. As Sir William Osler (1849–1919), one of the founding fathers of modern medicine and medical education, famously advocated, “Listen to your patient, he is telling you the diagnosis...”1 Active listening requires focused attention, not fragmented between a COW and the patient and his family. Our patients deserve our undivided attention, especially given the limited time we have during each encounter. Effective communication also involves demonstration and verbalization of AUTHOR: Christy L. Cummings, MD