The Elephant in the Room – How to make friends with the monitor in your exam room

Elephant in roomAt a recent doctor’s appointment, I was ushered into the exam room by an assistant. She never introduced herself and spent our entire time together with her back to me, facing a computer screen. As you can imagine, the interaction was far from the warm and welcoming “patient-centered” medical care that is now advocated. While she could easily have introduced herself and created a human-to-human moment, the presence of the computer creates challenges that are more complicated to deal with. No one likes the computer in the room. Our patients don’t like it, and neither do most of us. It adds to our workload, gets in the way of direct communication with our patients, and creates the impression in the minds of our patients that we aren’t listening to them.

But as much as we don’t like it, EHRs are here to stay. So what are we to do?

We can begin by being transparent with our feelings. We can let our patient know that we, too, are frustrated with our need to look at the computer, instead of at him. And then we can reassure him that we are, in fact, listening.

We can also use the computer in a more transparent way. Tell your patient what you’re doing, whether it’s entering his history, checking his meds, or looking over the note from a recent referral. That keeps him involved in the visit, rather than making him feel that you’re more involved with the computer than with him. Periodically, we can paraphrase what we just entered into his record. We’ll make sure that we’ve gotten his history right and also make the point that we are listening.

Situating the computer so we can face the monitor and our patient at the same time is wise. Sometimes it’s just not possible to do that, but every effort should be made to arrange the room so our patients are not staring at our back.

When there are functions of the EMR that can be shared – looking over the trends in lab data, for instance – we can show the monitor to our patient, so he understands that there is a benefit to this new occupant of the medical space.

And we need to be aware of those times when our eyes must be on our patient. If we want our patient to remember something we are saying, when we are telling him something serious or difficult, or when our patient is sharing something emotional, we absolutely need to make eye contact. Especially if we have just spent some time looking at the computer screen, our patient will notice this shift. He will sense the extra attention we are giving to the interaction and understand that, although we do spend more time looking away from him, we are listening and are there with him when he needs us.

For other suggestions regarding how best to incorporate the EHR into your patient visit, check out this post:

About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
This entry was posted in building relationship with patients, effective communication in healthcare, first impressions, physician coach, physician coaching, physician communication and tagged . Bookmark the permalink.

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