The electronic health record (EHR) has become the third wheel in the exam room, often getting in the way of physicians making meaningful connections with their patients.
“Both as a physician and on the receiving end as a patient, I have found that EHRs absolutely can cause certain barriers,” says Johnny Dias, DO, an internist with the Medical Group of the Carolinas in Spartanburg, South Carolina. “By starting to type in the computer, you can feel the disengagement from the patient.”
Payer documentation mandates have forced doctors to rely too much on the computer during exams, says Jack Ende, MD, an internist in Philadelphia, Pennsylvania, and president of the American College of Physicians. “We are in an age now where we are being required to over-document so we can demonstrate we’ve done things so we can get paid for them, and that’s all part of the problem,” Ende says.
But while finding the right balance between thorough documentation and a successful patient encounter may be difficult, it’s not impossible, physicians say. It requires understanding the doctor’s own style of conducting visits and the quirks of their EHR software and exam rooms, not to mention a strong dose of pre-planning and staff support.
The physician leads
While everyone can become absorbed in their electronic devices these days, during a patient exam it’s up to physicians to control the dynamic. A 2015 study in the International Journal of Medical Informatics that tracked the eye movements of doctors and patients during exams found that patient gaze and eye contact followed cues from the physician.
In other words, physicians must establish eye contact and create an inviting, engaging atmosphere for the patient.