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Computers May Not Always Benefit Doctor-Patient Relationship

Although exam-room computers may seem to support safer and more effective patient care, in fact it can be a threat to patient safety, good relationships and positive health outcomes.

In a commentary published in JAMA Internal Medicine, Regenstrief Institute Investigator and Indiana University School of Medicine Professor of Medicine Richard Frankel, Ph.D., writes that the medical profession can ill afford not to develop and implement patient-centric, exam room computer-use best practices. He presents POISED, a model he has devised for developing and reinforcing good exam room computer-use by physicians.

Prepare – review electronic medical record before seeing patient.

Orient – spend 1 to 2 minutes in dialogue with the patient explaining how computer will be used during the appointment.

Information gathering – don’t put off data entry as patients may question how seriously their concerns are being taken if physician does not enter information gleaned from patient into computer from time to time.

Share – turn the computer screen so patients can see what has been typed signaling partnership and also serving as a way to check that what is being entered is what was said or meant.

Educate – show a graphic representation on the computer screen of information over time, such as patient’s weight, blood pressure or blood glucose, so it can become basis for conversation reinforcing good health habits or talking about how to improve them.

Debrief – Exam room computers provide ideal opportunity to use “teach back” or “talk back” format for doctor to assess the degree to which recommendations are understood by the patient and correct as necessary.

“Being POISED for examination room computer-use need not cost additional visit time. Used well, just the opposite is true,” Frankel’s commentary concluded. “Medicine is fundamentally a human enterprise that is still practiced one conversation at a time. Our challenge is to find the best ways to incorporate computers [as care process partners] in the examination room without losing the heart and soul of medicine, the physician-patient relationship.”

Over the past decade Frankel, a medical sociologist and health services researcher who is also a Department of Veterans Affairs research scientist, has conducted a series of studies based on direct observation and videotaping of use of computer in the exam room and conducted extensive interviews with physicians. He and colleagues have found wide variation in examination room computer use: some physicians spend more than 80 percent of the visit time interacting directly with the patient, while others spend more than 80 percent of the visit time interacting with the computer screen.