The computer and the doctor-patient relationship.
Editor—Mitchell and Sullivan found no evidence that use of computers in consultations had negative effects on the patient outcomes evaluated. Doctors, Patients, and Computers. computer by Danielle Ofri New York Times and psychologically it has placed a wedge in the doctor-patient relationship. Doctors who rely heavily on computers while in the exam room may run the risk of harming their relationships with their patients.
No more X-rays lost in surgery clinic. But the presence of computers in the exam room has had another consequence. Both physically and psychologically it has placed a wedge in the doctor-patient relationship. In the old days, when a patient arrived in my office, I laid the paper chart on the desk between us. I looked directly at the patient.
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As we spoke, I would briefly drop my eyes to jot a note on the page, and then look right up to continue our conversation. My gaze and my body language remained oriented toward the patient nearly all the time.
In the current computerized medical world this is impossible. Like most internists, I know that the interview is the most important part of a patient visit.
It always yields far more information than the physical exam, which, in many ways, is an afterthought. But now that the computer is impeding the intimacy normally achieved during the talking part of the visit, I find that I rely on the physical exam more.
Once the patient and I have broken free from confines of the desk, with its dictatorial PC, we have a more comfortable realm, that of touch. As soon as there is skin-to-skin connection, conversation flows more easily. In the absence of a machine lodged between us, the traditional doctor-patient relationship is restored.
Still, after the physical exam, when we return to the desk to wrap up the visit, we are stuck back with the computer screen between us as I print out prescriptions, order labs and document all the elements of our visit in order to comply with the vast and ever-expanding charting requirements.
Computer use must not affect doctor-patient relationship
The clicking of the keyboard interrupts our conversation, and there are uncomfortable periods of silence as the patient waits for me to scroll through the seemingly endless number of screens in order to close the visit.
However, there is no practical way to keep up with the flow of work and the backlog of other patients waiting. Local record-keeping software permitted statistical analysis of patient lists only three years ago.
A revolution occurred with the development of the Internet and easy access to medical journals, multimedia files and consultant opinions. Patients may adopt new technology faster than doctors. High rates of internet use by patients for health information have positive effects on the doctor-patient relationship for both doctors and patients. Early evidence suggested that computers increased the length of consultations.
Video recordings with a group of family doctors over seven years showed that increased computer time resulted in less eye contact, closed body posture, and less time for patient talk. Perhaps good communicators do not change their habits.
Computer-centered doctors may formerly have focussed on paper charts. By placing the screen at an angle so that it is visible to both the doctor and the patient, the text becomes the property of both. The position of the computer on the desk can help classify doctors as inclusive or exclusive referring to their degree of patient centeredness in the consultation.iPad Brings New Wave in Doctor, Patient Communication
High quality computer records may come at the expense of patient centeredness. Others interrupt the conversation to enter notes as they go. Still others may interrupt only at the end of blocks of time, such as for recording of subjective and objective findings. Training in communication skills can minimize the adverse effects of the computer in the consulting room.
Doctors can maintain verbal, visual and postural communication with patients while using computers and modify the position of the computer on the desk to include patients in the consultation.
Computer based decision-making tools add time to the consultation. These figures are unworkable in the current reality in general practice. What can be done? Teachers of medicine need to inform their students of the benefits and harms of computer use in the consultation. Administrators need to listen to doctors and patients to determine their information technology needs. Systems must be rapid and transparent to allow doctors to get on with care.
Some clinical software used in Portugal does not allow the opening of multiple windows for data entry during the consultation. Family doctors still have to fight for the software they need to allow them to do their job well. We hope that our readers will pick up the challenge and continue to explore this fascinating area for the benefit of their colleagues and their patients. Isr Med Assoc J Sep; 11 9: