The last time I was in a physician’s office was a few months ago, when my family had a very important decision before us to have my teenage son undergo a major surgical procedure. During this visit, I had to actually make the request that the doctor put his computer away while we were going through the conversation. It was a serious decision and I wanted everyone to be engaged—especially the provider responsible for my son’s care plan. I didn’t feel like I could establish that trust that is so critical to the doctor/patient relationship (and doctor/family relationship) without him looking me in the eye and meaningfully focusing on the conversation.
While this experience frustrated me, it did not surprise me. It’s a common patient frustration in 2016:Northwestern University researchers discovered that physicians using EHRs spent about a third of patient visits looking at their screens. And all of that screen time can negatively impact the patient experience: AJAMA study published earlier this year found that patients rated the care they received lower when doctors looked at a computer screen a lot during patient examinations. Technology—from PCs and tablets to smartphones and wearables—has continuously increased its presence in healthcare. Overall, this is a good thing. Technology can streamline clinical workflows and improve care team communication. However, it’s also inhibited the human side of medicine.
As a clinical leader in hospitals and health systems, I was often asked “How do I ensure personal patient interactions while using a mobile device at the bedside?” Doctors want to give their undivided attention to the patient but face many pressures to log information into the EHR in real time in order to document for charge capture, reimbursement, and a host of other things. Oftentimes entering information into the EHR can spur questions for the physician to ask the patient as well, and the prompts can add value to the visit. When 98 percent of hospitals have an EHR system, it’s clear they aren’t going away. The trick is, then, to find a satisfactory answer to this question: “How can doctors co-exist with technology and still maintain that very human and personal doctor/patient relationship?”
I’ve seen physicians who achieve the best balance they can in the digital environment we’re all working in by doing a couple of different things. First, they practice mindfulness by just being cognizant that technology can be a barrier and making adjustments to engage the patient. For example, some doctors position themselves, the patient, and the screen into a triangle and do their best to talk the patient through what they are doing and recording. Indiana University School of Medicine Professor of Medicine Richard Frankel, Ph.D, has developed a model he calls POISEDfor developing and reinforcing good use of screen time, which includes sharing, educating, and other good practices that he says can actually save time. It doesn’t eliminate screen time by any means, but it does help balance the need to document with the need to build and maintain the relationship with the patient.
Second, they use other technologies besides the EHR to their advantage. PCs and mobile devices often fight for our attention with screen pop-ups, beeps, and buzzes. Many doctors set boundaries on those interruptions where they can to avoid any screen distractions that aren’t pertinent to the visit. They might turn off in-basket pop-ups when the patient record is full-screen. Or they might set their Spok Mobile® status to “Do Not Disturb” when they are having a serious conversation with a patient. Other physicians love their smartwatches because they can adjust their settings so incoming messages have a soft vibrate that’s perceptible only to them, allowing them to quickly glance at messages and ignore them if it’s not something they need to respond to immediately/while they are with the current patient.
I understand it’s not an easy task, and the doctors I speak with certainly understand the patient frustrations. By intentionally being cognizant of eye contact and focus, sharing and educating the patient on the documentation as you go, and using the available communications technology to minimize unnecessary disruptions, we can do our best as caregivers to keep the focus on the patient while using the technology to benefit their care. By working toward a peaceful co-existence with technology and balancing screen time with face-to-face interaction, you provide the requisite care, as well as the attention and compassion that’s needed to establish trust.
By Dr. Nat’e Guyton, RN, MSN, CPHIMS, NE-BC
Dr. Nat’e Guyton is Spok’s Chief Nursing Officer. She is a nurse and clinical leader with over 15 years of healthcare and technology experience that includes clinical workflow redesigns, EHR and health IT implementations, and pursuing interoperable, patient-centric, and user-friendly technology for quality outcomes. Guyton holds a bachelor’s and master’s degree in nursing, post graduate degrees in healthcare administration and healthcare informatics, and a doctorate in management-organizational leadership. She is an advocate for patients, for nurses, and for healthcare organizations.