Technology Consult

September 2, 2005

Staying eye-to-eye with patients.

"These laptops are great," said the blogger, herself an FP resident. "But from my experience with my primary care doctor last year, please don't be rude and only look at your laptop, entering information while you're eliciting a history from a patient. My doc ended up getting eye contact with me for about 30 seconds of a 10-minute interview."

This account underlines doctors' widespread fear that computer data entry in the exam room will weaken rapport with patients. True, you also can bury your head in a paper chart, but digital technology generally makes greater demands on your precious attention. The screen is swimming in buttons and boxes, it's alerting you to drug interactions and incoming messages, and your hands are busy with the keyboard and mouse. Woe to the doctor who hasn't mastered the software-or typing, for that matter.

However, a different picture emerged in a 2002 British study conducted by the National Health Service. Researchers videotaped doctors entering and viewing data on computers during patient visits. Some doctors turned away from the patient and typed for 20 seconds or more in silence, rendering patients silent as well. One tried to talk to a patient while he typed, but seemed to ignore an important statement she made. These findings soured the researchers on multitasking-doctors, they said, struggled to pay attention to a patient and a computer screen at the same time.

Fortunately, the British study's candid camera also captured doctors who stayed connected to patients despite the presence of a computer. Their behavior translates into a skill set that you can learn. Kaiser Permanente has even developed classes and training videos to help its doctors preserve the human touch in the e-health age. Here are some basics that you need to master:

Pick the right position. How you position a desktop or laptop in relationship to the patient greatly influences how much eye contact you'll make. In the worst configuration, you have to turn your back on the patient to enter data. The best configuration is a triangle formed by you, the monitor, and the patient. Put the monitor close enough to the patient so that it's easy to glance from one to the other. If you're behind a desk, the monitor could be on the far right side, with the patient seated next to it alongside the desk. For even better eye contact, face the monitor at a 45-degree angle. Sit close enough to the patient so that you can touch him or her when need be, adds Madison, WI, FP Paul Smith, who has been using a desktop in the exam room for six years.

Laptoppers can sit directly opposite patients and make eye contact over the screen, provided it's not too tall or the patient too short. However, if you plant the laptop on your lap you invite ergonomic pain, since you're working without wrist or elbow supports, notes ob/gyn Maxine Klein in Hartford, CT.