Doctors' computer use impacts how patients rate their care

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 - doctor consulting patient computer

How much a provider uses a computer during an appointment impacts patient satisfaction.

The more providers use computers, the more likely patients are to be less satisfied with their care, according to a study published in  JAMA Internal Medicine.

Researchers at the University of California-San Francisco and other institutions interviewed 47 patients diagnosed with at least one chronic condition who visited one of 39 doctors at a public hospital between 2011 and 2013. The interviews were conducted before and after the appointment. Patients in the post-appointment interview were asked to rate the quality of their care over the preceding six months.

The researchers also videotaped the appointments and used a scale of one-to-12 to rate the amount of time the physician spent using the computer to access EHRs to make referrals, prescribe medications, review test results and track healthcare maintenance. 

The researchers found that patients rated care as "excellent" in half of the 25 encounters with high computer use, compared with more than 80 percent of the 19 encounters with low computer use.

They also found that physicians who spent more time using the computer spent less time making eye contact with patients and 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.

However, study co-author Neda Ratanawongsa, MD, MPH, of the University of California-San Francisco, said such actions are not necessarily bad. "[EHRs] give important health information to clinicians, which may help safety-net patients with communication barriers like limited health literacy and limited English proficiency," she said.

The computer use doesn't necessarily indicate poor care quality, however, she noted. Issues with care can result in more computer use, which she said could be a reason for the connection between higher computer use and lower patient satisfaction.

"On the other hand, maybe patients sense that their clinicians aren't listening as carefully to them."

Richard Frankel, PhD, of the Indiana University School of Medicine, wrote an accompanying editorial, noting that physicians could miss opportunities to make emotional connections when they spend too much time on the computer.

"Technology in the exam room is neither good nor bad inherently," he wrote. There are techniques physicians can use to help patients become comfortable with technology, such as introducing patients to the computer and informing the patient how and why it is being used. Frankel also said that when possible, both the patient and provider should be able to view the computer screen.