Note: The conclusions in this piece are drawn from a patient interaction survey.
A common complaint of electronic health record (EHR) software is that it interferes with doctor-patient interactions. Many physicians lament that they can no longer engage fully with patients, instead spending most of their time looking at a computer screen and updating charts.
This leaves both doctor and patient frustrated: nobody becomes a doctor because they want to stare at a computer screen all day, and patients want to know that their physician actually cares about them–which means looking at their doctor’s eyes, not their back.
There’s no better way to gain insights into the in-office experience than to ask doctors outright. Elsewhere, we’ve surveyed patients and doctors about wait times, but here we’ve asked doctors how they’ve maintained the doctor-patient relationship in the digital era. Based on their responses, we’ve identified the following solutions.
1. Position your Computer between You and the Patient
The most common solution we heard was to make sure that your monitor or keyboard is somewhere that lets you face the patient, rather than being against the wall with your back to the room. Said one survey respondent, “We have laptops on workstations with wheels. We place the workstation between the docs and the patients. With the doc sitting down, eye contact is not a problem.
2. Invest in Mobility
As that respondent mentioned, an even better solution is to have a table on wheels, or an extendable arm that allows you to position the monitor anywhere you want it. For instance, you could turn the monitor around to show the patient any diagrams or charts. Of course, laptops and tablets provide mobility, too, and are usually well worth the investment.
3. Delegate as Much as Possible
You want to spend as little time as possible interfacing with the computer while you’re in the room. Dr. Jeffrey G. Kaplan, author of the Managing Managed Care blog, recommends having your nurses or PAs preload as much of the history of present illness (HPI) as possible, then reviewing that information before you go in. By the time you enter the room you should already have a pretty good understanding of the patient’s past and current history, including possible diagnoses and treatment plans.
4. Dictate as Much as Possible
Some doctors have a PA in the room who enters the data as the physician says it. Others use dictation software (which, if you tried it a few years ago and gave up on it, you should try again—it’s improved dramatically). Patients generally don’t mind, and on some level they may find it comforting since they still get the experience of hearing your voice, and you’re talking about them even if you’re not speaking directly to them.
5. Ignore the Computer when you First Enter the Room
Dr. Dominick Maino, professor at the Illinois Eye Institute, tells his students that they shouldn’t even look at the computer for the first five minutes of the patient encounter. Instead, focus one hundred percent on the patient. Once you’ve established rapport with them, only then should you turn to the computer and start documentation.
6. Ask about Previous Complaints
Earlier it was suggested that you review the HPI prior to entering the room. You should also ask about the patient’s history of prior injuries or chronic conditions. Then, when you’re in the room, ask if any of those issues persist. Depending on your EHR, those past encounters may still be “open” in the system anyway, so this gives you a chance to close them, and it reinforces to the patient that you care.
7. Finish the Chart in the Room
This gives the patient the opportunity to add details, ask questions, and make sure they understand the diagnosis or treatment. It may also help alleviate concerns that you didn’t spend much time with them.
Although EHRs can take some getting used to, once you familiarize yourself with the system and develop a process for working with them, they should make every patient interaction easier.