Patients vs. Screens

Doctors, it seems, are busier than they’ve ever been. Getting an appointment — especially with a specialist — can take weeks or months, and even when a visit is booked far ahead of time, there may be a long wait to see the doctor, and the visit may feel rushed when the doctor is finally available. Now, a new study confirms that there is yet another potential obstacle to meaningful interaction with doctors: computers in the examination room.

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If your doctor’s office is a typical one, its examination rooms will be outfitted with computers that let medical staff access electronic health records (EHRs). According to a 2011 study by the Centers for Disease Control and Prevention, 54% of all doctors — including 58% of primary care providers — used EHRs, and roughly half of those who didn’t use them were planning to adopt them within the next year. That same study found that 74% of doctors who used EHRs believed that they “enhanced overall patient care.” Among the benefits doctors reported were being able to quickly access patients’ charts, being alerted to critical lab test numbers, being alerted to potential medication problems and interactions, and being reminded to provide relevant preventive care. As Jan Chait noted in a Diabetes Self-Management article, however, EHRs cannot currently be shared easily with other practices or hospitals because of the closed nature of the computer systems in place.

A study released late last month, to be published in the March 2014 issue of the International Journal of Medical Informatics, demonstrates that EHRs may have a dark side in the doctor’s office. For the study, scientists at Northwestern University used discreetly placed video cameras to monitor doctor–patient interactions during visits at locations where EHRs were used. After recording 100 patient visits, they then painstakingly charted the eye-gaze patterns of both doctors and patients, as recorded on the video. According to a Northwestern University news release on the study, doctors typically spent about a third of each visit looking at a computer screen. Patients also tended to look at computer screens when doctors did, even though they may not have been able to understand or even really see what they were looking at. Compared with visits using old-fashioned paper charts, both doctors and patients spent more time looking at computer screens and less time looking at each other.

The study’s authors concluded that EHRs, as currently used, could interfere with doctors and patients building rapport and picking up on nonverbal cues from each other. Because of the effect screens have on the eyes of both doctors and patients, they suggested designing EHR software that can be used interactively, to better facilitate communication in addition to keeping records. This could involve, for example, displaying graphs showing patients’ histories of lab test results and weight and blood pressure measurements. But designing software for this purpose means, of course, that doctors and patients may spend even more of each office visit looking at a computer screen.

Does your doctor use EHRs and access them during office visits? If so, do you ever feel that the computer is an obstacle to good communication? Have you noticed any positive or negative changes in the general quality of care you received since your doctor’s office adopted EHRs? Is it time for all doctors to switch to using EHRs if they don’t already, or does this study show that paper has its merits? Leave a comment below!

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