The need for doctors to enter a patient's health data during an appointment may hinder their relationship and rapport, a new study says. Patients are less likely to rate the care received as excellent when doctors rely much on computers while seeing a patient in the examination room.

Researchers from the University of California, San Francisco (UCSF), Oregon Health and Science University and University of Hawaii found that the more doctors use computers in safety-net clinics, the lower the patient satisfaction rating they got. Safety net clinics refer to special clinics that serve people with restricted access to health care. 

"Many clinicians worry that electronic health records keep them from connecting with their patients," co-author Dr. Neda Ratanawongsa of the University of California, San Francisco said.

"So it's not surprising that we found differences in the way clinicians and patients talk to each other," she added.

Published in the journal JAMA Internal Medicine, the study was conducted from 2011 to 2013. Around 71 encounters among 47 patients and 39 clinicians at a public hospital were studied. 

Most of the patients had chronic diseases like type 2 diabetes, congestive heart failure and rheumatoid arthritis. To acquire the needed data, researchers interviewed the patients through a phone call before the appointment, recorded a video of the consultation and conducted another interview after the appointment.

The amount of time the physician or clinician used the computer during the whole duration of the consultation were rated on a scale of one to 12. Examination room computers are used to enter electronic health records to view test results, track health care maintenance, and record prescribed medications.

After six months, patients were interviewed again and they rated the quality of care they received from the clinician. Around 83 percent of patients whose doctors barely bothered with the computer rated the clinician's care as excellent.

On the other hand, the doctors of 48 percent of patients who used the computer for longer periods of time were given a poor rating. These doctors tend to spent less time talking to the patient, making eye contact and establishing rapport.

In an invited commentary by Dr. Richard Frankel, Regenstrief Institute Investigator and Indiana University School of Medicine Professor of Medicine said that using the computer can be done without sacrificing doctor-patient relationship.

He presented POISED, a model designed in the development and reinforcement of good examination room computer use for doctors.

Prepare - This entails reviewing the patient's record in the computer before seeing the patient.

Orient - This orientation will allow the doctor to explain to the patient the need for the computer in the room and how it can help with the consultation.

Information gathering - Gather relevant data from the patient and don't put off data entry as patients may doubt how serious their concerns are being taken if the doctor does not enter the information gleaned from patient into the computer from time to time.

Share - Turn the computer screen so patients can see what information has been encoded. This may build partnership in the plan of care of the patient.

Educate - Educate the patient by showing graphic representations of information such as their weight, blood pressure or laboratory results. These can become bases for conversations about healthy habits and how to improve figures.

Debrief - This can be an opportunity to use the 'talk back' format in order for the doctor to assess how much recommendations were understood by the patient. This can pave way for making crucial corrections.

"Medicine is fundamentally a human enterprise that is still practiced one conversation at a time. Our challenge is to find the best ways to incorporate computers [as care process partners] in the examination room without losing the heart and soul of medicine, the physician-patient relationship," Frankel said

Photo: Herry Lawford | Flickr

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