Screens are everywhere in our lives now, even in the exam room. More than 80 percent of doctors now use EHRs, and the hype is building surrounding new technologies in healthcare such as virtual reality. The benefits of technology are numerous—but we all know that too much tech isn’t a good thing for anybody.
The doctor-patient relationship can take a hit when computers take up too much time and attention in the exam room. A recent study shows that excessive use of screens by clinicians can inhibit communication and lead to poor patient satisfaction scores.
Like it or not, screens are here to stay in medicine. So what can doctors do to make sure they are using computers effectively and not negatively impacting their patients? It starts with being aware, and includes specific strategies like the doctor-developed POISED method. Read on.
The impact of computers on patient satisfaction and communication
A study published by JAMA Internal Medicine evaluated patients at safety-net hospital clinics, which serve populations with limited health literacy and limited proficiency in English. Researchers videotaped doctor-patient encounters and categorized physicians’ computer use as low, moderate, or high. The impact on patients of high computer users was significant—and not in a good way.
Fewer than half of the patients of physicians with high computer use during clinical encounters rated the care they received as excellent on patient experience surveys. In contrast, “the majority (83 percent) of patients whose physicians were less engaged with their computers during the encounter felt the care they received was excellent,” reports Medscape.
It was also found that the use of EHRs can affect communication between patients and providers. The study authors noted that high computer use in the exam room “may inhibit authentic engagement, and multitasking clinicians may miss openings for deeper connection with their patients.”
Another study analyzed eye-gaze patterns in physicians and patients during visits in which EHRs were used. Researchers found that EHRs affect the patient-physician eye contact dynamic differently than paper charts. Less time was spent looking at each other, and more time was spent looking at the computer.
How screens can affect trust and empathy
Why do things like eye contact matter in the exam room? “Eye contact establishes trust and a bond with patients and a lack of it can be alienating. It also prevents physicians from being able to read body language and cues from patients,” writes Sumathi Reddy in the Wall Street Journal article, “Is Your Doctor Getting Too Much Screen Time?” Experts say lack of eye contact is the biggest problem with having to input information into a computer, she notes.
Giving your patients your full attention, rather than your EHR, also allows you to pick up on those subtle clues that may lead to a more accurate diagnosis. Dr. James Doty, Director of the Center for Compassion and Altruism Research and Education (CCARE) at Stanford University School of Medicine, tells the WSJ about a patient who came to see him for chronic back pain.
After observing her appearance and behavior during their initial meeting, Dr. Doty became convinced there was more to the story. Instead of just following routine protocol and looking at her X-rays, he dug deeper and discovered the patient had a history of unhappiness and sexual abuse. Instead of scheduling back surgery, he referred her to a psychiatrist. Six months of treatment later, the patient was free of back pain.
“If your patient feels rushed, if they feel you’re not really with them, or that they’re just another number, you won’t establish that trust you need to create a connection where your patient feels you truly care, and vice versa,” Dr. Doty told the WSJ.
Lastly, don’t underestimate the importance of touch. If you’re touching your keyboard and not your patient, you could be missing out on a valuable chance to bond. “The power of touch, even if it is a quick cardiorespiratory exam, matters to patients and provides an opportunity to strengthen the patient-physician bond,” writes Jennifer Frank, MD, in Physicians Practice.
Stay POISED in the exam room
So how can doctors navigate the fine line between getting the benefits of technology and relying on it too much? The answer may be how you are using screens in your practice.
In a commentary published in JAMA Internal Medicine last November, Regenstrief Institute Investigator and Indiana University School of Medicine professor of medicine Dr. Richard Frankel presented a model he has devised for developing good exam room computer-use by physicians, called POISED. This stands for:
Prepare. Review EHR before seeing a patient.
Orient. Spend a couple of minutes explaining to the patient how the computer will be used during the appointment.
Information gathering. Don’t put off data entry, as patients may question how seriously their concerns are being taken if the physician does not enter the info they’re providing into the computer from time to time. (Note: some doctors use medical scribes for this purpose.)
Share. Turn the computer screen so patients can see what has been typed. This fosters partnership and also lets patients verify the accuracy of the information.
Educate. Dr. Frankel suggests showing patients graphs of their own data, such as weight, blood pressure, or blood glucose, as a basis for conversation about good health habits. Showing them patient education videos on a tablet is another good way to explain conditions or treatment plans and reach visual learners.
Debrief. Exam room computers provide an ideal opportunity to use the “teach back” method for the doctor to assess whether recommendations are understood by the patient and correct as necessary, according to Dr. Frankel.
Some doctors, typically those from older generations, refuse to bring screens into the exam room at all. Others delegate the health-history intake and patient education portions of the visit to other staff members. But some doctors have found a happy medium that allows them to harness the positive aspects of technology in the exam room, while not letting screens become a barrier between them and their patients.
As Dr. Jennifer Frank writes, “Every moment I spend looking at a patient, touching, speaking to, or comforting a patient is valuable and should not be delegated or reassigned. To me, it’s not about increasing efficiency, it’s really about reducing the load that tends to distract us from interacting directly with our patients.”
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