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Distracted Doctoring? Don’t Let Computer Come Before Patient During Exam

By Susan Kreimer | November 14, 2017

The relatively new era of electronic health records is creating more work for physicians rather than simplifying documentation. 

ehr exam room.jpg In an exam room "triangle of trust," a physician can see the patient and the computer without shifting, and the patient can view the screen as well. | 123RF Stock Photo

If only it were simple to seamlessly integrate electronic devices into the office visit, neither patients nor physicians would feel frustrated with “distracted doctoring.”

It’s a term Wei Wei Lee, MD, MPH, uses to describe what transpires when health care providers become more focused on technology than the patients sitting in front of them. Admittedly, documentation requirements can be burdensome, disrupting a physician from delivering face-to-face care with ample eye contact and empathy.

As a medical educator, Lee helped design a workshop to train clinicians in a better balancing act — capitalizing on electronic health records to enhance patient-provider communication rather than detract from it.

“When you’re in the exam room with the patient, you want to use all the tools that the computer has to offer,” says Lee, an assistant professor of medicine and assistant dean of students at the University of Chicago Pritzker School of Medicine.

wei lee  nameline.jpgReviewing recent X-rays and lab tests together can prompt a discussion about those results, engaging patients in their health care. But first, she recommends beginning the visit free of technology. In the initial “golden minute,” it’s essential to greet the patient, ask about any concerns and set an agenda for the appointment, says Lee, who serves on the core faculty of the internal medicine residency program.

The next step forms a “triangle of trust”— a configuration with the physician, patient and computer positioned at three corners. From this vantage point, the physician can see the patient and the computer without shifting, and the patient can view the screen as well.

Sharing information in this manner optimizes the patient-provider interaction.

“This really helps promote patient education, but it’s also to make sure that the doctor is being transparent,” Lee says.

To foster humanism in medicine, in 2013 she received a grant from the Arnold P. Gold Foundation, which promotes compassionate, collaborative and scientifically sound care. With the foundation’s support, her research team developed a curriculum to teach providers how to remain focused on the patient while attending to the demands of the computer.

RELATED: Team-Based Approach Puts a Dent in Physician's EHR 'Pajama Time' 

Part of the distraction stems from the relative infancy of electronic medical records, which still need a lot of tweaking. So far, these systems have not lived up to their high expectations, creating more work for physicians rather than simplifying documentation, says Richard I. Levin, MD, president and chief executive officer of the foundation, based in Englewood Cliffs, N.J.

“Doctors entered the profession to help and care for humans,” he says. “They did not sign up to be scribes or billing agents.”

Discussing usability issues with software vendors can help physicians become more discerning in their choice of new technology “before signing on the dotted line,” says Rod Piechowski, MA, senior director at the Healthcare Information and Management Systems Society.

 “There is an array of technology that people are being asked to use, and yes, some of it is a distraction from what you’re trying to do,” he says. “That’s one of the transitional problems with moving from a paper-based world to one of electronic documentation.”

Using technology to prepare for a patient visit can enhance communication. Instead of foraging for information in electronic records during precious appointment time, physicians eventually will be able to command the computer to pull up major highlights, says Paul Tang, MD, MS, a practicing internist at the Palo Alto Medical Foundation in California, and vice president and chief health transformation officer at IBM Watson Health.

RELATED: In Clicks vs. Checks, the Computer Is Winning Over the Doctor's Time

In February, the company entered into an agreement with Atrius Health in eastern Massachusetts to develop a cloud-based service supporting shared decision-making between physicians and patients. The service is expected to summarize key points about a patient’s health status, assemble a deidentified cohort of individuals similar to the patient and describe their outcomes under various treatment options, says Tang, who also advised the federal Office of the National Coordinator for Health Information Technology.

“If I use the computer to glean relevant insights about the patient before walking into the exam room, I'll be able to spend my time in the room discussing what's most important to the patient and coming up with a shared plan to improve his or her health,” he says. 

Topics: Patient Care/Quality, Technology

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