Doctors' use of computers during appointments leaves patients less satisfied

(Reuters Health) - Doctors who entered data into computerized health records during patients’ appointments did less positive communicating, and patients rated their care excellent less often, in a recent study.

“Many clinicians worry that electronic health records keep them from connecting with their patients,” said Dr. Neda Ratanawongsa of the University of California, San Francisco, who co-authored the research letter.

“So it’s not surprising that we found differences in the way clinicians and patients talk to each other,” she said.

But doctors who used the computer more also spent more time correcting or disagreeing with patients, she told Reuters Health by email.

The researchers used data from encounters between 47 patients and 39 doctors at a public hospital between 2011 and 2013.

The patients had type 2 diabetes, rheumatoid arthritis or congestive heart failure, and sometimes more than one of those chronic conditions. All spoke English or Spanish. Researchers interviewed them by phone before their appointment, videotaped the appointment, and interviewed the patients again after their visit.

Using the tapes, the researchers rated how much each physician used the computer during the appointment on a scale from one to 12. The electronic health records could be used to review test results, track health care maintenance, prescribe medications and refer patients to specialists.

In the post-appointment interview the patients rated the quality of their care over the past six months.

About half of the 25 encounters with high computer use were rated as “excellent care” by the patients, compared to more than 80 percent of the 19 encounters with low computer use, as reported in JAMA Internal Medicine.

Doctors who spent more time using the computer spent less time making eye contact with patients and tended to engage in more “negative rapport building,” correcting patients about their medical history or drugs they’ve taken based on information in the electronic record.

That’s not necessarily a bad thing, Ratanawongsa said.

“For example, a primary care provider says, ‘No, the cardiologist actually wants you to stop taking that medication,’” she said. “Electronic health records give important health information to clinicians, which may help safety net patients with communication barriers like limited health literacy and limited English proficiency.”

Problems in care may lead to more computer use, which would explain the link between computer use and lower patient satisfaction, she said.

“On the other hand, maybe patients sense that their clinicians aren’t listening as carefully to them,” she said.

Doctors who spend most of the time looking at the computer may miss out on an emotional connection with the patient, said Richard M. Frankel of the Indiana University School of Medicine, Indianapolis, who wrote an editorial accompanying the story.

“When people are paying attention to the same thing at the same time, you get the best transmission of information,” Frankel told Reuters Health by phone. “Technology in the exam room is neither good nor bad inherently,” but doctors can use specific techniques to help patients get comfortable with it, he said.

They should introduce the patient to the computer and explain how and why they will be using it. If possible, it can be arranged so both doctor and patient can see the screen, he said.

In addition, doctors can look up frequently and make eye contact to reestablish the relationship, Frankel said.

“Just under half of my patients have limited health literacy and about half speak a language other than English,” Ratanawongsa said. “The computer helps me know about their health and their health care.”

“The hard part is figuring out how to help care teams access and add to this information AND still stay present with patients in the room,” she said.

Electronic health records “need to be more usable so clinicians with varying computer proficiency can use them without struggling and diverting focus from patients,” Ratanawongsa said.

SOURCE: JAMA Internal Medicine, online November 30, 2015.