Background
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.
Objective
To determine whether physician experience modifies the impact of exam room computers on the physician–patient interaction.
Design
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.
Measurements
Physician and patient assessment of the effect of the computer on the clinical encounter.
Main Results
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.
Conclusion
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.
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References
Inui TS, Carter WB. Problems and prospects for health services research on provider–patient communication. Med Care. 1985;23(5): 521–38.
Stewart MA. Effective physician–patient communication and health outcomes: a review. CMAJ. 1995;152:1423–33.
Hall JA, Horgan TJ, Stein TS, Roter DL. Liking in the physician–patient relationship. Patient Educ Couns. 2002 Sep;48(1):69–77.
Kaplan SH, Greenfield S, Ware JE, J. Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med Care.1989;27:S110–S127.
Schneider J, Kaplan SH, Greenfield S, Li W, Wilson IB. Better physician–patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. J Gen Intern Med. 2004 Nov;19(11):1096–103.
Roter DL, Hall JA, Katz NR. Relations between physicians’ behaviors and analogue patients’ satisfaction, recall, and impressions. Med Care.1987;25:437–51.
Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor–patient relationship and malpractice. Lessons from plaintiff depositions. Arch Intern Med. 1994;154(12):1365–70.
Lester GW, Smith SG. Listening and talking to patients. A remedy for malpractice suits? West J Med. 1993;158:268–72
Blendon RJ, Schoen C, Desroches C, Osborn R, Zapert K. Common concerns amid diverse systems: health care experiences in five countries. Health Aff (Millwood). 2003 May–Jun;22(3):106–21.
Woolf SH, Kuzel AJ, Dovey SM, Philips RL, Jr. A String of mistakes: the importance of cascade analysis in describing, counting, and preventing medical errors. Ann Fam Med. 2004 Jul–Aug;2(4):292–93
Greenfield S, Kaplan S, Ware, JE, Jr. Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985 Apr;102(4): 520–28.
Hulka BS, Cassel JC, Kupper LL, Burdette JA. Communication, compliance, and concordance between physicians and patients with prescribed medications. Am J Public Health. 1976;66:847–53.
Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. Jul–Aug 1999;6(4):313–21.
Versel, N. One in five group practices now use EHRs. Health IT World News Newsletter 2. 1-25-2005. Health-IT World. 11-15-2005
Institute of Medicine, Committee on improving the patient record. The computer-based patient record: An essential technology for health care. Washington, DC: National Academy Press, 1997.
Rollman BL, Hanusa BH, Lowe HJ, Gilbert T, Kapoor WN, Schulberg HC. A randomized trial using computerized decision support to improve treatment of major depression in primary care. J Gen Intern Med. 2002; 17:493–503.
Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med. 2003;163:1409–16.
Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998;280:1339–46.
Roter DL, Frankel RM, Hall JA, Sluyter D. The expression of emotion through nonverbal behavior in medical visits. Mechanisms and Outcomes. J Gen Intern Med. 2006 Jan;21(Suppl 1):S28–S34.
Waitzkin H. Doctor–patient communication. Clinical implications of social scientific research. JAMA. 1984 Nov 2;252(17):2441–46.
Mitchell E, Sullivan F. A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980–97. BMJ. 2001;322:279–82.
Frankel R, Altschuler A, George S, et al. Effects of exam-room computing on clinician–patient communication: a longitudinal qualitative study. J Gen Intern Med. 2005;20:677–82.
Rubin HR, Gadnek B, Rogers WH, Kosinsky M. Patients’ ratings of outpatients visits in different practice settings: results from the Medical Outcome Study. JAMA. 1993:270:835–40.
Liang KY, Zeger SL. Longitudinal data analysis using generalized linear models. Biometrika. 1986;73:13–22.
Makoul G, Curry RH, Tang PC. The use of electronic medical records: communication patterns in outpatient encounters. J Am Med Inform Assoc. 2001;8:610–5.
Ridsdale L, Hudd S. Computers in the consultation: the patient’s view. Br J Gen Pract. 1994;44:367–9.
Solomon GL, Dechter M. Are patients pleased with computer use in the examination room? J Fam Pract. 1995;41:241–4.
Ornstein S, Bearden A. Patient perspectives on computer-based medical records. J Fam Pract. 1994;38:606–10.
Gadd CS, Penrod LE. Dichotomy between physicians’ and patients’ attitudes regarding EMR use during outpatient encounters. Proc AMIA Symp. 2000;275–9.
Legler JD, Oates R. Patients’ reactions to physician use of a computerized medical record system during clinical encounters. J Fam Pract. 1993;37:241–4.
Aydin CE, Rosen PN, Jewell SM, Felitti VJ. Computers in the examining room: the patient’s perspective. Proc Annu Symp Comput Appl Med Care. 1995;824–8.
Herzmark G, Brownbridge G, Fitter M, Evans A. Consultation use of a computer by general practitioners. J R Coll Gen Pract. 1984;34:649–54.
Warshawsky SS, Pliskin JS, Urkin J, et al. Physician use of a computerized medical record system during the patient encounter: a descriptive study. Comput Methods Programs Biomed. 1994;43:269–73.
Als AB. The desktop computer as a magic box: patterns of behaviour connected with the desktop computer; GPs’ and patients’ perceptions. Fam Pract. 1997;14:17–23.
Rowe BH, Ryan DT, Therrien S, Mulloy JV. First-year family medicine residents’ use of computers: knowledge, skills and attitudes. CMAJ. 1995;153:267–72.
Aaronson JW, Murphy-Cullen CL, Chop WM, Frey RD. Electronic medical records: the family practice resident perspective. Fam Med. 2001; 33:128–32.
Embi PJ, Yackel TR, Logan JR, Bowen JL, Cooney TG, Gorman PN. Impacts of computerized physician documentation in a teaching hospital: perceptions of faculty and resident physicians. J Am Med Inform Assoc. 2004;11:300–9.
Acknowledgment
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
None disclosed.
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Rouf, E., Whittle, J., Lu, N. et al. Computers in the Exam Room: Differences in Physician–Patient Interaction May Be Due to Physician Experience. J GEN INTERN MED 22, 43–48 (2007). https://doi.org/10.1007/s11606-007-0112-9
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DOI: https://doi.org/10.1007/s11606-007-0112-9