Health tech as perceptual barrier. A study published Monday in JAMA Internal Medicine-Online First (limited content) found that patients were noticeably less satisfied their care when the physician used the computer (e.g. EHR) during the appointment. According to Reuters, only half of the 25 visits 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. iHealthBeat cited that physicians who spent more time on the screen:
- Spent less time making eye contact with patients
- Tended to do more “negative rapport building,” such as correcting patients about their medical history or drugs taken in the past based on information in their EHR.
The researchers (primarily from the University of California–San Francisco) used data from two years of visits by 47 patients to 39 doctors at a public hospital. The patients had Type 2 diabetes, rheumatoid arthritis or congestive heart failure, with some having multiple chronic conditions. What is downplayed is that the patients were considered ‘safety net’ patients with communication barriers–limited health literacy and often limited English (primary Spanish speakers). But even this special population may be pointing to an overall problem regardless of education with the perception of doctors ‘not listening to patients’, countered by the valuable information an EHR can convey from primary care physician to specialist, and vice versa. Again, it’s perception and style. Taking a little time to make eye contact and introducing the patient to the computer and the information contained may well counter this detached impression. Also commentary in same issue by Richard Frankel, PhD adds that setup of the exam room can modify the central placement of the computer to make less of a barrier, and reviewing the record before entering the room would be helpful.