Are You POISED in the Exam Room? 6 Tips for the Wired Physician

Like it or not, computers are changing how doctors and patients interact, and not always for the better. Could physicians’ computing habits be part of the problem?

Recent evidence says “yes,” and as computers become permanent fixtures in exam rooms (sometimes literally), unexpected drawbacks are becoming apparent. According to medical sociologist Richard M. Frankel, PhD, the lack of best practices and industry-wide standards is partly to blame. Dr. Frankel advises that to promote high quality doctor-patient interactions, everything from the computer’s physical placement to the individual physician’s use patterns must be considered.

Encouragingly, he notes scholarly interest in what he calls “the human cost of technology” is growing. Based on his own extensive research, Dr. Frankel offers the POISED model, six guidelines for responsible computer use habits:

  1. Prepare: Over half of all ophthalmologists spend less than 12 minutes with each patient. Maximize that time by reviewing the patient’s record before entering the exam room. This limits “non interactive pauses”, a communication habit that can reduce patient satisfaction.
  2. Orient: Don’t use the computer for the first one to two minutes of the appointment. Instead, set the stage by engaging in dialogue. Then, alert the patient to the fact that you’re going to be using the computer (there’s an interesting relationship between orientation statements and malpractice claims.
  3. Information Gathering: Patients expect you to use the computer at certain times, such as during information gathering portions of the appointment. Failing to enter data into the computer at these times can make the patient feel as if you are minimizing their concerns.
  4. Share: Position yourself so you are either facing or next to the patient. Allow them to see what you are typing. Patients want to feel like your partner in their care, and patient participation is a key factor in improved treatment outcomes, especially when it comes to managing chronic conditions.
  5. Educate: Approximately two-thirds of people are visual learners. Take advantage of the screen and visually display the patient’s data while discussing their care. Most EHRs will integrate images from OCT scans or visual field tests, and translate data into graphs, charts, or histograms.
  6. Debrief: Use the “teach back” method to ensure your patient understands your care instructions. The computer can be your ally when explaining health information, incorporating videos, printed instructions, or interactive tools.

Today’s eye care practices are facing a dichotomy. Better patient outcomes are supposed to be a driving force behind the adoption of new technologies, but the goals of being both data-driven and patient-centered still seem at odds for many physicians. Adhering to the POISED model could help bridge that gap.

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