Their comprehensive study of the effect of exam room computer placement and the doctor-patient relationship appears in the August issue of the Journal of General Internal Medicine.
The researchers found that doctors with poor communications skills tended to get lost in the computer, interacting with it rather than the patient. Doctors with good communications skills used eye contact and posture to show interest even while working on the exam room computer.
"You may have a great diagnosis but if you can't communicate it to the patient, he or she may not follow-up appropriately," said Richard Frankel, Ph.D., author of the study. Dr. Frankel, Professor of Medicine and a medical sociologist.
Dr. Frankel notes that other studies, including many pioneering ones from Regenstrief researchers, have examined the effect of computers on patient outcomes and quality of care, but have not evaluated the impact of technology on doctor-patient communications. His study investigates the impact of technology on the professional interaction between patient and physician.
The placement of the computer in the exam room is critical to the communication process, the new study determined.
"If the computer is poorly positioned, it either gives you a really sore neck from turning around if you want to engage your patient or you wind up with the back of your head to the patient," said Dr. Frankel. "This really created difficulties for a lot of the doctors we studied. They would do one of two things – they would either not use the computer or they would not pay attention to the patient.
"Other technology in the exam room has a known relationship to the ecology of the room. The blood pressure cuff is typically sitting next to exam table and its placement varies very little from room to room. But with computers, we found they could be anywhere in the exam room where it was convenient to drop the wires," said Dr Frankel.
Ideally, the computer should be placed on a moveable arm that can be swiveled to a position that allows for eye contact between the doctor and patient, he said. Eventually, he hopes that medical school students routinely will be taught how best to use computers when interacting with patients.
The study was funded by Kaiser Permanente's Garfield Memorial Fund.
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