Docs tickling the computer keys a turnoff to patients: JAMA

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.

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  1. The English, on the other hand, feel much more comfortable talking about medical matters when the doctor isn’t looking directly at them. According to the anthropologist Kate Fox in her excellent book ‘Watching the English’, if prompted to reveal what’s really on their minds, English patients are inclined to reveal more when the doctor is standing behind them pretending to listen to their chest or when turned away attending to their computer. (Pages 242-245 in the 2014 paperback edition.)

  2. Donna Cusano

    Steve, an interesting insight into ethnic styles of communication. What would be your guess (or research) on the Spanish and French?

    The US in many areas is now culturally skewing far more to the Southern Hemisphere and even Asian style of ‘high-touch and close-in’ which puts far more of premium on contact. I believe you’d still find areas in the US which would be more English-style. Yet overall, voices seem to be getting softer and less understandable which makes it difficult for older doctors with some hearing loss…also wrestling with computers. The psychiatric journals are wrestling with the latter problem; it doesn’t help that behavioral health EHRs are by and large miserable.

  3. Nice piece, though the findings are really quite intuitive aren’t they?

    I was in San Francisco last week at the Aging 2.0 Expo and visited with Augmedix, a startup company that has a very cool solution for the problem of MD distraction due to data inputing and charting. They are adding in remote scribes to the appointment via Google glass, thereby freeing up the doctor to focus on patients for the 5 minutes each of us get with them these days. They claim that they can save doctors up to 2 hours a day. Check them out at

    • Donna Cusano

      Dov, if Google Glass is not going into production as it appears, what is the company’s alternative? Also GG 2nd in itself in current version a bit offputting.

      • Dov Sugarman

        Good question Donna.

        According to Google, while they have put the GG consumer product on hold for now, they are continuing to support and in fact push initiatives in the health care space. I’m not sure if this means that there will be future versions of the product or not…