Electronic medical record use and physician–patient communication: An observational study of Israeli primary care encounters
Section snippets
Background
The past decade has transformed the technology of information exchange, and consequently, how modern society records, organizes, archives, and retrieves information. Within the context of health care delivery, one manifestation of the information revolution is the increasingly commonplace use of the electronic medical record (EMR) [20]. This is particularly evident in Israel and Europe. Current estimates suggest that EMR use by Israeli physicians is now so high as to represent an almost fully
Methods
This is an observational study of 3 primary care physicians, and a convenience sample of 30 of their patients, drawn at random from a larger study of medical education. The original investigators videotape-recorded the consecutive consultations of 8 family physicians and 233 of their patients in 6 academic family medicine clinics in northern Israel. An EMR system had been in use in the study clinics for over 5 years.
Overview
The length of the consultation ranged from 2.4 to 22 min with an average of 11 min. Physicians typically faced the desktop computer and patients did not have a view of the screen. Twenty-four of the 30 study visits were with adult patients and 6 were pediatric visits. A total of 20 female and 10 male patients’ visits were analyzed. The primary diagnoses varied widely and included acute conditions (i.e., upper respiratory infections, pain symptoms [back, chest, knee, and abdominal pain], ear
Discussion
In some respects, the computer has become a third party in medical visits, one that demands a significant portion of visit time. On average, physicians spent close to one-quarter of the visit gazing at the computer screen, and in some cases it was as much as 42% of visit time. These findings add specific numbers to the observation by Greatbatch et al. who reported that physician's visual attention was ‘largely’ directed to the monitor [13], as well as the work of Theadom et al. who noted
Conclusions
This study suggests that the way in which physicians use computers in the examination room can negatively affect patient-centered practice by diminishing dialogue, particularly in the psychosocial and emotional realm. Screen gaze appears particularly disruptive to psychosocial inquiry and emotional responsiveness, suggesting that visual attentiveness to the monitor rather than eye contact with the patient may inhibit sensitive or full patient disclosure. Keyboarding diminished dialogue overall,
Acknowledgements
We thank the physicians and patients who agreed to participate in this study and Israel Rabinowitz, M.D., who collected the primary data.
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Cited by (0)
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At the time of the study, a Research Fellow at The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.