What do you think?

Our clinical curriculum has focused on teaching us the skill of communicating with our patients, of making eye contact, reading body language and leaving space for the patient to talk. After practicing these things in the simulation center with standardized patients, I was feeling pretty comfortable stepping into my longitudinal clerkship placement with an ob/gyn. Then I realized that the real world doesn’t always work like the sim center – the real world requires using computers with electronic medical records. Of course this has MANY advantages... but one huge disadvantage is how computers change the way we communicate with patients.

Dr. R. is a great clinician. His patients trust him, confide in him, ask questions, raise concerns and talk to him honestly. Unfortunately, patients are talking to his back about 50% of the time while he reads ultrasound reports, updates the record, writes orders, electronically submits a prescription to the patient’s favorite pharmacy, or writes a note for the patient’s employer. Truthfully, I understand that it’s much more efficient to do the “paperwork” while sitting with the patient – but I’m frustrated that in exchange for saving time and being efficient, Dr. R. must compromise his communication and relationship building opportunities. There have been a few times when I have seen the patient’s body language or facial expression from where I stand and it has been clear that Dr. R. did not understand their question or did not recognize a patient’s hesitation or unease.

One of the main reasons for this situation is the set up of the exam rooms; the computer is on the counter and faces the wall. There has been talk about this problem being solved with tablet computers or iPads, and I hope this will be the case soon. The other factor is that Dr. R. likes to spend time with his patients in the exam room instead of splitting the patient’s scheduled time with time at his computer. One of Dr. R.’s colleagues doesn’t actually touch the computer while in the exam room with her patient. But she remains efficient by spending less time with her patients and stops at the workstation between patients to update the electronic medical record and sign orders.

It’s tough to say which option allows the most “face-time” with the patient. I would like my patient to know that I’m listening to them and to be able to talk face-to-face the entire time. I also want to be able to read my patient’s body language and observe their symptoms and signs of illness. This would likely inhibit me from using the computer to get the “paperwork” done efficiently and effectively, but would also require I leave the patient room before their appointment is over so that I can take care of the paperwork before seeing the next patient.

I'd really like to know what some readers think about this situation in their doctor's office. Does your doctor turn his or her back to you while typing on the computer? How does this make you feel? Would you rather your doctor use the computer while in the room with you so that you know the records are being updated with the correct information? What should I strive for as far as communicating with patients?