When the time spent in front of a doctor's screen reduces the time spent in front of patients' faces

While Wei Wei Lee was sitting with her doctor to discuss the creation of a family, she felt a "distance" between them. The doctor was busy on the computer and focused on the screen.

"It did not seem very personal," Lee said. "I did not feel heard."

It seemed that keeping a record of the conversation was more important for the doctor than establishing a connection with Lee.

It was not the experience that she wanted, but she could tell: Lee is Dr. Wei Wei Lee, primary care physician at the University of Chicago Medicine.

When she started using electronic health records (EHRs) in the examination room, Lee also had difficulty. She would apologize to the patients for not giving them her full attention. And Lee spent precious time trying to move from one task to another, she says.

Today, Lee is studying the influence of electronic health records on the doctor-patient relationship. She is interested in improving the "computer way" of doctors.

Electronic health records can help reduce medical errors, but when they are not used properly, they can harm the doctor-patient relationship.

But medical providers – and patients – can gain the skills to maintain communication even when there is a screen in the room, said Lee.

The improvement of doctor-patient communication is the subject of this week's episode of the podcast "One arm and one leg". Kaiser Health News co-produces the podcast.

KHN spoke to Lee about his patient survey at the University of Chicago Medicine. Lee found that the vast majority of them were pleased that doctors are using computers in the examination room. But some people felt that their appointments had been moved to them. And the body language of the medical provider sometimes made communication more difficult:

"In the past, the patient could be the center of attention during this visit. Now, the doctor really divides his attention between placing orders and working on the computer without paying full attention to the patient. So, eye contact, back to the patient, annoying silences while the doctor is looking at something in the computer – all this can cause difficult communication problems for the patients.

These "awkward silences" can have consequences, Lee said.

"Most patients want to see a doctor to feel they are being heard so they can really talk to them about what's bothering them. When the computer is not used properly, the patient is often less likely to use this doctor if he felt disconnected from the way he communicated. Medical errors are another thing that can happen. If the doctor is more distracted during this visit, it is possible that the medications are badly ordered or not record a part of the history that is relevant.

Lee and his colleagues have developed strategies to help doctors better understand their patients while working with a computer. There is now a program to teach clinicians how to use EHRs in a "patient-centered" way.

"This is largely due to behaviors and skills that are not insidious. For example, start the visit without any technology. Greet your patient Honor this minute of gold. Establishing a rapport and a conversation at the first minute can really go a long way. Another thing that has proved very useful is screen sharing.

So what does an effective screen sharing look like? Instead of placing the computer between the patient and the doctor, the doctor can move his chair next to the patient so that he sits side by side, suggested Lee. Then the computer is placed in front of them – to form a triangle. And if a computer still prevents you from talking, Lee says that patients should not hesitate to speak. His team has developed a comic book using a simple ABC mnemonic to teach these skills to people. Ask To see the screen. Become involved. Ceverything for the attention.

I think that speaking up and asking for that attention is a way to continue building that relationship with your doctor, because that behavior may not be known to doctors. Sometimes they talk about a sensitive topic or raised issues and want the doctor's attention. In those moments, I think it's okay to say, "Is it OK if we talk without a computer for a few minutes?"

I think it also helps to signal to the doctor that the patient is finding something important.