Physicians' Compassion, Communication Skills, and Professionalism With and Without Physicians' Use of an Examination Room Computer: A Randomized Clinical Trial (original) (raw)
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Computer use in primary care and patient-physician communication
Patient Education and Counseling, 2015
The study followed a descriptive cross-sectional design and included 106 family physicians (65 specialists and 41 trainees) and 392 patients from a Health Centers Grouping in the north of Portugal. Sociodemographic and professional characterization of the participants (physicians and patients) was obtained. An original questionnaire was used to evaluate computer use and placement in the consultation room and participants' perspective of its impact. Empathy (Jefferson Scale of Physician Empathy-JSPE) and patient centered strategies (Patient-Practitioner Orientation Scale-PPOS) were assessed. Results: Physicians reported spending 42.4% (SD = 16.4) of consultation time in contact with the computer. Patients perceived their physicians spending 35% (SD = 20.7) of consultation time interacting with the computer. Physicians perceived a negative impact of computer in patient-physician communication regarding the consultation length (-0.31, 1.2), confidentiality (-0.38, 1.1), maintaining eye contact (-1.12, 0.9), active listening to the patient (-0.72, 0.8), and ability to understand the patient (-0.03, 0.7). Patients reported a positive effect for all the items, with significantly higher scores, when compared with physicians, for the consultation length (+0.72, 1.0), confidentiality (+0.83, 1.0), maintaining eye contact (+0.57, 1.2), active listening to the patient (+0.64, 1.1), and ability to understand the patient (+0.81, 1.1). Physicians considered that the usual (current) computer location was significantly unfavourable to patientphysician communication. Conclusion: Physicians perceive the impact of computer use on patientphysician communication as negative, while patients have a positive perception of computer use impact on patient-physician communication. Practice Implications: Consultation support technologies are designed to improve quality of health care and facilitate information access. They can however represent a challenge to physicians who perceive its negative impact in patient centered orientation and empathy. Medical education programs aiming to enhance specific communication skills and to better integrate computer use in primary care settings are needed.
Patient Education and Counseling, 2006
Objectives: Within the context of medical care there is no greater reflection of the information revolution than the electronic medical record (EMR). Current estimates suggest that EMR use by Israeli physicians is now so high as to represent an almost fully immersed environment. This study examines the relationships between the extent of electronic medical record use and physician-patient communication within the context of Israeli primary care. Methods: Based on videotapes of 3 Israeli primary care physicians and 30 of their patients, the extent of computer use was measured as number of seconds gazing at the computer screen and 3 levels of active keyboarding. Communication dynamics were analyzed through the application of a new Hebrew translation and adaptation of the Roter Interaction Analysis System (RIAS). Results: Physicians spent close to one-quarter of visit time gazing at the computer screen, and in some cases as much as 42%; heavy keyboarding throughout the visit was evident in 24% of studied visits. Screen gaze and levels of keyboarding were both positively correlated with length of visit (r = .51, p < .001 and F(2,27) = 2.83, p < .08, respectively); however, keyboarding was inversely related to the amount of visit dialogue contributed by the physician (F(2,27) = 4.22, p <. 02) or the patient (F(2,27) = 3.85, p < .05). Specific effects of screen gaze were inhibition of physician engagement in psychosocial question asking (r = À.39, p < .02) and emotional responsiveness (r = À.30, p < .10), while keyboarding increased biomedical exchange, including more questions about therapeutic regimen (F(2,27) = 4.78, p < .02) and more patient education and counseling (F(2,27) = 10.38, p < .001), as well as increased patient disclosure of medical information to the physician (F(2,27) = 3.40, p < .05). A summary score reflecting overall patient-centered communication during the visit was negatively correlated with both screen gaze and keyboarding (r = À.33, p < .08 and F(2,27) = 3.19, p < .06, respectively). Discussion: The computer has become a 'party' in the visit that demanded a significant portion of visit time. Gazing at the monitor was inversely related to physician engagement in psychosocial questioning and emotional responsiveness and to patient limited socio-emotional and psychosocial exchange during the visit. Keyboarding activity was inversely related to both physician and patient contribution to the medical dialogue. Patients may regard physicians' engrossment in the tasks of computing as disinterested or disengaged. Increase in visit length associated with EMR use may be attributed to keyboarding and computer gazing. Conclusions: This study suggests that the way in which physicians use computers in the examination room can negatively affect patientcentered practice by diminishing dialogue, particularly in the psychosocial and emotional realm. Screen gaze appears particularly disruptive to psychosocial inquiry and emotional responsiveness, suggesting that visual attentiveness to the monitor rather than eye contact with the patient may inhibit sensitive or full patient disclosure. Practical implications: We believe that training can help physicians optimize interpersonal and educationally effective use of the EMR. This training can assist physicians in overcoming the interpersonal distancing, both verbally and non-verbally, with which computer use is
Procedia Computer Science, 2016
We evaluated the perceived impact of computer use on family physicians communication skills, empathy and quality of care. The study surveyed 106 family physicians and 392 patients. They were questioned regarding the utilization and impact of computer use in the consultation and its association with communication skills, physician's empathy (Jefferson Scale of Physician Empathy-JSPE) and quality of care (QUOTE-COMM questionnaire). Physicians reported spending a considerable amount of time interacting with the computer during the consultation (42.4%±16.4 of the total length). They perceive the impact of computer use as negative, while patients have a general positive perception of computer use on patient-physician communication. According to the patients the ability to be more compassionate and understand patient's perspective was not associated with the use of computer, but quality of care was negatively associated with time spent interacting with the computer. Interacting with the computer consumes a significant amount of clinicians' time during consultations and may represent a challenge to their communication ability and particularly to empathic attitudes. Patient's perspectives regarding the use of the computer in the consultation, computer use skills and related quality of care are valuable, and will contribute to shape future educational interventions.
Effects of exam-room computing on clinician-patient communication
Journal of General Internal Medicine, 2005
OBJECTIVE: To evaluate the impact of exam-room computers on communication between clinicians and patients. DESIGN AND METHODS: Longitudinal, qualitative study using videotapes of regularly scheduled visits from 3 points in time: 1 month before, 1 month after, and 7 months after introduction of computers into the exam room. SETTING: Primary care medical clinic in a large integrated delivery system. PARTICIPANTS: Nine clinicians (6 physicians, 2 physician assistants, and 1 nurse practitioner) and 54 patients. RESULTS: The introduction of computers into the exam room affected the visual, verbal, and postural connection between clinicians and patients. There were variations across the visits in the magnitude and direction of the computer's effect. We identified 4 domains in which exam-room computing affected clinician-patient communication: visit organization, verbal and nonverbal behavior, computer navigation and mastery, and spatial organization of the exam room. We observed a range of facilitating and inhibiting effects on clinician-patient communication in all 4 domains. For 2 domains, visit organization and verbal and nonverbal behavior, facilitating and inhibiting behaviors observed prior to the introduction of the computer appeared to be amplified when exam-room computing occurred. Likewise, exam-room computing involving navigation and mastery skills and spatial organization of the exam-room created communication challenges and opportunities. In all 4 domains, there was little change observed in exam-room computing behaviors from the point of introduction to 7-month follow-up. CONCLUSIONS: Effective use of computers in the outpatient exam room may be dependent upon clinicians' baseline skills that are carried forward and are amplified, positively or negatively, in their effects on clinician-patient communication. Computer use behaviors do not appear to change much over the first 7 months. Administrators and educators interested in improving exam-room computer use by clinicians need to better understand clinician skills and previous work habits associated with electronic medical records. More study of the effects of new technologies on the clinical relationship is also needed.
Journal of the American Medical Informatics Association : JAMIA, 2015
The effects of electronic health records (EHRs) on doctor-patient communication are unclear. To evaluate the effects of EHR use compared with paper chart use, on novice physicians' communication skills. Within-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication. A large academic internal medicine training program. First-year internal medicine residents. Residents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale. Thirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p<0.05). The overall average...
Clinician style and examination room computers: a video ethnography
Fam Med, 2005
The use of computers in medical examination rooms is growing. This technology has rapidly become a standard of care for general practitioners in many countries, especially in Europe. 1,2 In the United States, while examination room computers (ERCs) still remain relatively uncommon, 3 their use is being promoted as a way to reinvigorate primary care practice and reduce medical errors. 4,5 Institutional advocates of this technology suggest that all family physicians should have and use ERCs within the near future as evidenced by the Future of Family Medicine Project's recent recommendations. The easily quantifiable advantages and disadvantages of computerized medical records have already been well established and summarized elsewhere. 7,8 Few studies, however, have examined how ERCs affect the real-time progress of the clinical visit. 9-13 These few studies note that physicians using ERCs preferentially structure interviews around data-gathering demands rather than patients' own narratives. 14 Physicians using ERCs actively clarify clinical information, encourage medically related questions, and ensure completeness at the end of visits. At the same time, they also neglect outlining patients' agendas, exploring psychosocial and emotional issues, and discussing how health problems affect patients' lives. 13 As well, physicians using ERCs engage in a variety of computer-related behaviors that patients find confusing. 9-11 The influence ERCs have on the physician-patient relationship remains unclear.
Computers in the clinical encounter: a scoping review and thematic analysis
Journal of the American Medical Informatics Association, 2016
Objective Patient-clinician communication has been associated with increased patient satisfaction, trust in the clinician, adherence to prescribed therapy, and various health outcomes. The impact of health information technology (HIT) on the clinical encounter in general and patient-clinician communication in particular is a growing concern. The purpose of this study was to review the current literature on HIT use during the clinical encounter to update best practices and inform the continuous development of HIT policies and educational interventions. Methods We conducted a literature search of four databases. After removing duplicates, reviewing titles and abstracts, performing a full-text review, and snowballing from references and citations, 51 articles were included in the analysis. We employed a qualitative thematic analysis to compare and contrast the findings across studies. Results Our analysis revealed that the use of HIT affects consultations in complex ways, impacting eye...
Journal of the American Medical Informatics Association, 2005
The aim of this study was to evaluate the impact of introducing health information technology (HIT) on physician-patient interactions during outpatient visits. Design: This was a longitudinal pre-post study: two months before and one and seven months after introduction of examination room computers. Patient questionnaires (n = 313) after primary care visits with physicians (n = 8) within an integrated delivery system. There were three patient satisfaction domains: (1) satisfaction with visit components, (2) comprehension of the visit, and (3) perceptions of the physician's use of the computer. Results: Patients reported that physicians used computers in 82.3% of visits. Compared with baseline, overall patient satisfaction with visits increased seven months after the introduction of computers (odds ratio [OR] = 1.50; 95% confidence interval [CI]: 1.01-2.22), as did satisfaction with physicians' familiarity with patients (OR = 1.60, 95% CI: 1.01-2.52), communication about medical issues (OR = 1.61; 95% CI: 1.05-2.47), and comprehension of decisions made during the visit (OR = 1.63; 95% CI: 1.06-2.50). In contrast, there were no significant changes in patient satisfaction with comprehension of self-care responsibilities, communication about psychosocial issues, or available visit time. Seven months post-introduction, patients were more likely to report that the computer helped the visit run in a more timely manner (OR = 1.76; 95% CI: 1.28-2.42) compared with the first month after introduction. There were no other significant changes in patient perceptions of the computer use over time. Conclusion: The examination room computers appeared to have positive effects on physician-patient interactions related to medical communication without significant negative effects on other areas such as time available for patient concerns. Further study is needed to better understand HIT use during outpatient visits.
Family medicine, 2002
Trust and satisfaction in the physician-patient relationship is the cornerstone of family medicine. Today, computers are playing an increasingly prominent role in the delivery of health care, yet recent data detailing their effect on the physician-patient relationship are limited. For physicians to "first do no harm," it is critical to determine that computers used at the point of care do not decrease patient satisfaction, because this is a good proxy for the physician-patient relationship. This study assessed patients' views of computer use and its effect on patient satisfaction in a family medicine clinic before and after implementation of an electronic environment developed by our institution. A survey was mailed to patients who had been evaluated at a family medicine clinic for hypertension, high blood pressure without hypertension, or hyperlipidemia. These diseases were selected because they are common and require strong physician-patient relationships for success...