Computers in the Exam Room: Differences in Physician–Patient Interaction May Be Due to Physician Experience
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The use of electronic medical records can improve the technical quality of care, but requires a computer in the exam room. This could adversely affect interpersonal aspects of care, particularly when physicians are inexperienced users of exam room computers.
To determine whether physician experience modifies the impact of exam room computers on the physician–patient interaction.
Cross-sectional surveys of patients and physicians.
Setting and Participants
One hundred fifty five adults seen for scheduled visits by 11 faculty internists and 12 internal medicine residents in a VA primary care clinic.
Physician and patient assessment of the effect of the computer on the clinical encounter.
Patients seeing residents, compared to those seeing faculty, were more likely to agree that the computer adversely affected the amount of time the physician spent talking to (34% vs 15%, P = 0.01), looking at (45% vs 24%, P = 0.02), and examining them (32% vs 13%, P = 0.009). Moreover, they were more likely to agree that the computer made the visit feel less personal (20% vs 5%, P = 0.017). Few patients thought the computer interfered with their relationship with their physicians (8% vs 8%). Residents were more likely than faculty to report these same adverse effects, but these differences were smaller and not statistically significant.
Patients seen by residents more often agreed that exam room computers decreased the amount of interpersonal contact. More research is needed to elucidate key tasks and behaviors that facilitate doctor–patient communication in such a setting.
Key wordscomputers electronic medical record physician–patient relations
We thank Dr. Stewart Babbott, MD, for his editorial review of the manuscript. The corresponding author conducted the research during his general Internal Medicine fellowship, which was supported by a grant from the Health Resources and Services Administration. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of VA.
Potential Financial Conflicts of Interest
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