A new report form the Annals of Family Medicine finds that the computer, if used well by a skilled physician, can enhance the patient-doctor relationship.
Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis finds that when used, the electronic health record (EHR - the medical record, patient education materials, and Internet search capabilities) can add a valued dynamic to the patient relationship and enhance therapeutic relationships.
However, the computer can weaken the patient-doctor relationship if the physician uses it as a substitute for dialogue with the client. Therefore, it depends on ‘how’ the doctor uses the computer.
Whether the computer enhances or weakens the relationship depends both on how easy it is to use and how skilled physicians are in making use of it.
These conclusions were derived from a study of participant observation (80 hours) in 4 primary care offices and individual interviews with 23 physicians, 52 patient and other support works. This was accompanied by 5 focus-groups of participants.
"Physicians were often conflicted between recording data in the EHR and giving patients one-on-one attention," wrote the study's authors, led by William Ventres of Multnomah County Health Department in
Ventres (et all) found four key factors in influencing this relationship:
- Spatial Factors - for example, how the physical location of the computer monitor influenced dialogue between the patient and doctor (“Large, fixed monitors located in the corner of the examination room caused consternation among both physicians and patients, whereas flat-screen monitors on mobile arms were universally praised.)
- Relational Factors - how doctors and patients used and perceived the computer. "There are times where it’s obvious you’re going through a structured way of dealing with a presenting problem. It’s click, click, point, and your note is done. Then there are these much more complex, human interactions. It just isn’t appropriate to be sitting there typing at the time,” was a quote offered by one of the study’s participant doctors.
- Educational Factors – how skilled and experienced the doctor in using the computer and EHR.
- Structural Factors - factors such as the cost and funding for EHR, and how the host organization (e.g. clinic or hospital) perceived and influenced (culture) the use of EHR.
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