From My Exam Room To Yours

By Dr. Perri Klass

There were at least four screens in the exam room with the toddler. There was the desktop computer, of course, with the EPIC chart open, and there was the monitor with the interpreter, and there was the phone in the hand of the toddler’s adolescent sister, who was busy texting, and there was the phone in the resident’s hand because he was looking up a medication that the mother had just handed over, something they had brought with them from another country, and trying to figure out what it was.

None of these were “bad” screens, or screens being used in “bad” ways. Everyone was using them appropriately, from the adolescent sibling who was quietly communicating with friends while obligingly spending the afternoon at a toddler’s primary care visit, to the resident, who was entering information into the electronic health record while double checking an unknown medication on the web. But in order to figure out why his patient might have taken that medication, he had to look to the monitor with the interpreter, ask the question that was translated for the mother who then took out her own cell phone and sent a text message, seeking more information from another family member.

In fact, that exam room was the locus of a miraculous amount of information transfer, interactions which would not have been possible without technology and screens. We had a trained medical interpreter present — virtually — so the mother could ask and answer questions in her own language (which was not one of the three or four more common languages in the clinic). We had the resources of the internet and also instant connections to extended family to help us figure out what had been going on with that medication. We had the electronic health record which, well, was what it is. That exam room was buzzing with language and meaning and words and even, if you will, with stories.

But the resident had also brought in a board book for the toddler, and I have to say, it was almost a physical relief to watch him hand it to his patient — a real book, a book you could hold and handle and chew on and manipulate and even throw on the floor and pick back up. The mother put her cell phone back in her pocket and smiled, and the resident reached over and helped the toddler open the book. The toddler pulled it away and handed it to his mother. Through the interpreter on the monitor, the resident said to her, “Look at the pictures with him! Tell him the names of the things in the pictures”. Through the interpreter on the monitor, the mother said she would. Through the interpreter on the monitor, the resident told the mother, he’s learning language all the time; he wants to hear your voice. Language and meaning and words and stories — they have to start somewhere.