by Wei Wei Lee, MD MPH
“She made zero eye contact. She stared at the computer the entire visit.” This was my friend Pat’s lasting impression of her visit to her new physician. She felt like she was distracting the doctor from her primary focus, the computer, all the while trying to answer personal questions about her reproductive history.
Technology integration in health care is an unstoppable trend. The federal government has invested billions of dollars to incentivize electronic medical records (EMR) adoption, and utilization rates in the United States are on the rise. Nonetheless, as Pat discovered at her appointment, studies show that EMR use can prevent providers from focusing on patients and negatively impact the patient-provider relationship (see papers by Toll, Frankel and Ventress).
As a primary care physician, I know first-hand that integrating computers, EMRs, tablets, smartphones and other devices into the clinical environment changes the dynamic of the patient-provider relationship. “Distracted doctoring” refers to providers who are more focused on their devices than their patients. This phenomenon has spurred discussion at medical schools and hospitals across the country. That being said, most providers receive little to no training on how to use the EMR to enhance their communication with patients rather than detract from it .
As a medical educator interested in promoting humanism in medicine, I wanted to address this gap, so I developed curricula on how to use the EMR to enhance patient-provider communication. Through the support of the Gold Foundation, I had the good fortune of connecting with eight likeminded educators to develop a workshop addressing this emerging issue at the Harvard Macy Institute’s 20th anniversary symposium.
As presenters, we drew from our backgrounds in nursing, psychology, ethics, general medicine, geriatrics and neurology to highlight the cross-disciplinary impact of this issue. During the interactive session we addressed:
- The impact of technology use on the patient-provider relationship
- Best practices culled from the literature
- The ‘tools’ needed to develop and implement curricula
- Our experiences implementing curricula for medical students, residents and faculty at the University of Chicago, Brown University, and the Cleveland Clinic
Discussions showed that our workshop was timely and relevant for the practitioners and educators who joined us from around the country and around the world. We discussed the challenges of teaching this curriculum to providers with poor baseline communication skills and exchanged ideas and strategies to address this issue. We presented participants with our Ten Tips to enhance EMR related communication skills. Here are our top three:
- Golden Minute: Make the start of the visit completely technology free. Greet the patient, start with their concerns and establish an agenda for the visit before engaging technology.
- Triangle of Trust: Physically create a triangle configuration that puts you, the patient and the computer at the three corners. This allows you to look at both the patient and screen without shifting your body and also allows the patient to see the screen.
- Maximize patient interaction: Share what you’re seeing on the screen with the patient; review labs, history and other relevant information together. Use the EMR and online resources as an opportunity for patient education.
At the end of the session, one participant came up to us to say “This is an important topic to discuss. The tips you presented were useful and I will utilize a lot of this starting today.” After the workshop session, we heard from participants in Boston, New York and Chile who were interested in adapting our workshop for their faculty and trainees. In the end, our workshop allowed participants to share concerns about the impact of technology use on patient–provider communication and provided strategies for optimizing the EMR to re-humanize the practice of medicine.
If you would like a toolkit on how to teach this topic at your institution, please contact Wei Wei Lee at Wlee6@uchicago.edu. We welcome comments or suggestions on this post.
Wei Wei Lee, MD MPH, is an Assistant Professor of Medicine at the University of Chicago. She is the Assistant Dean of Students at the Pritzker School of Medicine and Core Faculty for the Internal Medicine Residency Program. She was selected as a Gold Humanism Scholar at the Harvard Macy Program for Educators in 2013, where she developed curricula to teach providers how to optimize technology use to promote patient-centered care.