Physician viewpoint: EHR's tone, word usage can fuel physician insecurities

After Zuckerberg San Francisco General Hospital transitioned to an Epic EHR, Emily Silverman, MD, an internal medicine physician at the hospital, noticed the system's voice began to make her feel insecure as a physician.

In a Nov. 1 op-ed for the New York Times, Dr. Silverman explained that on her first day logging into Epic she received a pop-up box with an urgent message, which stated "You currently have deficiencies that are either delinquent or will become delinquent within one week. Please complete at your earliest convenience." The message made Dr. Silverman question whether she had already done something wrong, even though it was her first day using the system.

Further, the tone of the message, "You currently have deficiencies," and words used seemed "harsh" and "punitive," Dr. Silverman wrote.

Technology companies and platforms often take on their own tone or voice; Dr. Silverman's friends who work at Facebook told her they use the platform's voice to make its users feel a particular way. With actions like birthday reminders, presenting old photos and messages of nostalgia and even offering words of condolences when a friend has passed away, Facebook can make Dr. Silverman feel cared for, she wrote.

Conversely, while companies like Facebook and Rent the Runway, which presents as a fun, cheerful voice, use tone and word choice to evoke good emotions from its users, Epic does not appear to take the same action, according to Dr. Silverman. When trying to delete an incorrect diagnosis on a patient's list of medical programs, it is much easier to "resolve" it, even though the word choice "suggests an expectation of unmitigated success," Dr. Silverman wrote.

"Checking in on a beloved patient who was hospitalized? Enter his chart and an accusatory pop-up may appear: 'Deceased Patient Warning: You are entering the medical record of a deceased patient. Are you sure you want to proceed?'" she wrote. "This can be a jarring way to hear the news. But Epic offers no condolences, no empathy, no acknowledgment that doctors, too, have beating hearts."

The medical field has cultivated a culture of perfectionism, which has contributed to physicians' suffering from high rates of burnout, depression and suicide, according to Dr. Silverman. However, Epic's voice does not seem to consider this. "Instead, we are met with relentless reminders of tasks we haven't completed, supplications to correct our documentation for billers, and daily, jaundiced reminders 'You are currently deficient,'" Dr. Silverman wrote.

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