No one chooses emergency medicine for continuity of care. It's undoubtedly rewarding for most doctors to help manage patients through growth or disease, but the emergency physician doesn't get the chance to appreciate a patient's development over time.
Until now.
Electronic health records at my institution now give us over 9 years of continuity. Even when I'm just meeting a patient for the first time, I can look back and see their first visit to the pediatric ED for asthma, the appendectomy from a few years ago, the gastritis visit during college break that may or may not have been related to alcohol.
For older patients, I can see the visits that described the out-of-control hypertension, the subsequent CABG and later, stents... the descent into heart and renal failure.
I get a little nostalgic to see almost-forgotten names of residents and attendings who cared for these patients, before they graduated or took other positions. It's like we were all a part of this patient's life.
Recently I re-open a patient's old chart, to show a resident an unusual EKG from a while back. I felt a pang, when my EHR alerted me the patient had died.
It's tempting to compare electronic health records to other means of keeping up with people, electronically. Research suggests social networks are changing the nature of relationships - rather than a few close friends with whom we share important news and feelings, we're instead updating a wider, but shallower, group of acquaintances with more mundane aspects of life.
While that may be true, EHR's ability to show the timeline of a patient's past care is having a profound effect on emergency medicine - where before there were discrete events, EHR is giving the semblance of an ongoing relationship. Physicians may debate whether electronic records are worth the investment, but to my mind there's no question the investment is more than financial.
