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8 ways for doctors to improve computer use in care delivery
Bad habits could jeopardize physician-patient relationships and cause safety concerns.
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Computer manners matter
Physicians who get preoccupied with entering data into an electronic health record during a patient visit can hurt the doctor-patient relationship and potentially endanger patients, contends Richard Frankel, a medical sociologist at Regenstrief Institute who studies physician use of their computer during medical exams. That’s because some doctors spend 80 percent of the visit entering data instead of interacting with patients. Aided by a grant from the Department of Veterans Affairs, Frankel has created an eight-point process for reinforcing good exam room computer use that also can lead to better outcomes.
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1. Prepare
Review the electronic health record before seeing the patient.
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2. Orient
Spend one to two minutes in discussion with the patient explaining how the computer will be used during the appointment.
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3. Information gathering
Don’t put off data entry because patients may question how seriously their concerns are being taken if a physician does not enter information gleaned from the patient into the computer from time to time.
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4. Share
Turn the computer screen so patients can see what has been typed—this signals that there is a partnership between the patient and physician, and it also serves as a way to check that what is being entered is what was said or meant.
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5. 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 a basis for conversation reinforcing good health habits or talking about how to improve them.
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6. Debrief
Exam room computers provide ideal opportunity to use “teach back” or “talk back” formats for doctors to assess the degree to which recommendations are understood by the patient—and then make corrections as necessary.
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7. Gender differences
Female physicians typically look up from the screen approximately every 30 seconds or so, making eye contact with the patient to signal that they are still actively engaged in the relationship, and then return to typing. However, male physicians tend to lock their gaze on the computer screen and rarely look up to signal engagement, Frankel says.
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8. Balancing act
Not surprisingly, patients prefer doctors who they believe are paying attention to them. As a result, Frankel believes the need of physicians to electronically document must be balanced against the need to build and maintain relationships with patients. “The computer can be a handicap,” he concludes, “but there are ways in which that handicap can be overcome through good and appropriate education and use.”