Computers Make Mumbling Doctors Worse, Good Doctors Better

When technicians place computers in patient exam rooms, the position of patients and clinicians should matter more than that of wires and electrical outlets. That’s one common-sense conclusion from one of the first studies to evaluate the impact of computer technology on interactions between patients and physicians.

The study analyzed 54 patient visits conducted by nine clinicians before, one month after and seven months after a large medical practice installed computer screens in exam rooms.

“The most frequently used decision of where to place the computer was where it was convenient to drop the wires,” said Richard Frankel, a medical sociologist at the Indiana University School of Medicine and author of the study. “That turned out to be in the corner of the room so that the clinician had his back to the patient.” Not surprisingly, the placement interfered with doctor-patient communication. The study will appear in the August issue of the Journal of General Internal Medicine.

Another finding was less intuitive. Computers in exam rooms help doctors communicate with patients, but only if the doctor already communicates well. For doctors with poor interaction skills, computers exacerbate their problems. Such doctors tended to interact more with the computer and less with the patients.

Further, after six months’ experience using computers during patient visits, clinicians did not improve in their abilities to organize information exchange, make regular eye contact with patients, or navigate through computer screens. One likely reason is that the practice had already used the electronic medical record for several years, so the only difference was that physicians were now being asked to record information during a patient visit rather than inputting information after the encounter.

For computers to improve communication, clinicians “have to move to the computer record being seen as an educational tool, not notes to self,” said Frankel. Indeed, the skilled communicators did this instinctively. For example, they would tilt computer screens to show patients previous lab results or drug information. They would also clarify any discrepancies between what a patient told them and what appeared on the computer screen.

For less skilled communicators, the computer, rather than the patient, became the focus of the visit. Clinicians seemed confused if a patient described a reason for a visit that differed from that on the computer screen.

That doesn’t mean that poor communicators should shun computers, said Frankel, adding that communication training improves patients’ satisfaction with doctor visits. Clinicians will change when they’re made aware of the issues, he said. “It’s a relatively simple thing to encourage clinicians to turn the screen and make eye contact.”

Another issue may not be so simple to solve, probably because it clashes with the ubercompetent image doctors are often expected to project. “Many physicians are embarrassed by poor typing skills,” said Frankel, “so they won’t use the EMR with the patient in the room.”

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