Exam Room Computing Has a Downside. Here’s the Data to Prove it.

Have you ever strained to make eye contact with a patient over the top of a laptop screen? Or wrestled with a drop down menu as a patient anxiously lists his or her symptoms?

Most physicians have, and the irony is inescapable. In the exam room and beyond, the very devices designed to facilitate communication are decreasing the quality of interpersonal connections. It’s not just your imagination—a study published earlier this year in JAMA confirms that there is indeed an “elephant” in the room (the exam room, that is).

High computer use in the exam room is associated with lower patient satisfaction and markedly different communication styles.

Over two years, lead researcher Neda Ratanawongsa, MD, PMH and his University of California, San Francisco-based research team observed and interviewed patients and practitioners at the UCSF Center for Vulnerable Populations at San Francisco General Hospital. Physicians were scored on four computer-related behaviors:

  1. Time spent reviewing on-screen data
  2. Time spent typing or clicking the mouse
  3. Frequency of patient eye contact
  4. Presence of noninteractive pauses

Researchers also analyzed the content and tone of physicians’ and patients’ verbal statements, placing them into one of four “rapport building” categories:

  1. Positive (agreement, laughter)
  2. Negative (disagreement, criticism)
  3. Emotional (empathy, cooperation)
  4. Social (small talk or chit chat)

You can probably predict the results: Patients were less satisfied with encounters involving high computer use. Those encounters involved less positive rapport building by patients, more negative rapport building by physicians, and more social rapport building by both.

But wait! Social rapport sounds like a good thing…. right?

While valuable for establishing trust and likeability, the desirable aspects of social rapport building may diminish when coupled with high computer use. Physicians using statements in this category while simultaneously computing could be misinterpreted as being distracted or unauthentic.

Technology’s direct effect on the patient care process is an important consideration no matter what, but physicians working with underserved populations—like the study’s “safety-net” location—should be especially vigilant. Socioeconomically unstable individuals are at increased risk for visual impairment. They also often have a low level of health literacy and limited use of the English language. As a result, high computer use during the exam could exacerbate already-existing communication barriers.

Up Next: Simple ways to improve your communication with patients—even when you’re using an EHR.

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