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Some patients find the use of a computer during a consultation irritating, particularly if the GP has poor keyboard skills. By Megan Howe.
THE doctor-patient relationship has always been revered as the Holy Grail of good health care, but there is a third player in most consultations today — the computer.
While most patients accept that a GP will tap away on a keyboard or glance at the computer screen while they explain their ills, some remain uncomfortable about the computer’s presence in the surgery.
A survey of 1250 patients commissioned by Australian Doctor and Pfizer Australia found that while most patients (80%) were happy for their GP to use a computer during their visit, 15% felt it detracted from the consultation.
Computers are now used in 95% of practices, mainly for prescribing (83%) and billing (79.9%), although more than two-thirds of practices (68.8%) use computer-based medical records, according to the BEACH study of general practice activity in Australia 2003-04.
Professor Siaw-Teng Liaw, president of the Australian College of Health Informatics, describes the patient-computer-doctor triad as an “interesting phenomenon”.
He is surprised that the number of patients who feel the technology detracts from the consultation is not greater than 15%, saying that the computer is “very in your face” compared with paper notes.
A pilot study1 of computer use in GP consultations in Australia that he co-authored found that in a consultation of 14 minutes, the doctor spent about 90 seconds interacting with the patient while using the computer and about 42 seconds solely with the computer.
Professor Liaw, chairman of rural health at the University of Melbourne, says patients’ acceptance of GPs’ computer use is influenced not only by the amount of time spent on the computer, but by whether the GP appears confident using it, where it is positioned in the surgery and whether the GP engages the patient while using the computer.
“I think it is an important issue,” he says. “But at the end of the day, it doesn’t matter really where you place the computer [in the surgery], it’s how you engage the patient into this thing called a computer sitting on your desk.”
Ms Maureen Henninger, senior lecturer in knowledge and information management at Sydney’s University of Technology, stresses that GPs must be competent when using technology in their surgery.
If not, watching them fumble with the computer will frustrate the patient — because they can probably use the technology better — and they may conclude the doctor is not only lacking in computer skills, but in clinical skills.
As one patient told Australian Doctor: “It’s fascinating watching some quite young docs fiddle tentatively with the mouse, and mutter to themselves and the computer, while you are trying to tell them about your sore toe. You wonder where they have been.”
A US study2 several years ago showed patients were generally comfortable with a physician using a computer during their visit, and thought computers had a positive effect on the quality of care they received. However, that perception changed if the doctor had poor computer skills.
“Use of computer systems that have awkward interfaces, forcing them to stumble around during the visit, are likely to lead to patients viewing physicians as ‘computer illiterate’.”
Dr David Guest, a GP in Goonellabah, northern NSW, whose practice is fully computerised, describes the use of computers in consultations as a “trade-off”.
“We all like a relationship where you look each other in the eye and the other person appears to be hearing what you are saying, and using a computer to do patient notes detracts from that,” he says.
But computer-based medical records help GPs keep comprehensive patient notes, which are valuable for good health care.
“One of my advantages, which I think is true for many younger doctors, is that I have keyboard skills — I can touch-type — so I can mostly look at the patients and eyeball them while I make brief notes on the keyboard without having to look at he screen,” Dr Guest says.
After using the computer in the consulting room for at least five years, he says most patients are comfortable with it and he often shows them relevant information or pathology results on the screen.
He says it’s only the occasional new patient who expresses concern.
“I’ve had a new patient say, ‘Do you know how distracting that tapping away on the computer is?’” Dr Guest reassures them, “You’ll get used to it.”
1. Australian Family Physician 2005; 34:400.
2. Family Medicine 2002; 34:362-68.
THE SURVEY
The Australian Doctor/Pfizer Australia questionnaire involved a representative sample of 1253 patients aged 18 and over Australia-wide, and was conducted by Stollznow Research as part of the Pfizer Australia Health Report.
POINT OF REFERENCE
MOST patients will be pleased if you reach for a reference book or check information on the Internet during a consultation, with women more comfortable about GPs using reference material than men (86% versus 76%).
However, the Australian Doctor/Pfizer Australia survey shows that one in 10 patients become concerned if a GP uses reference material such as books, journals or the Internet during a consultation because they believe a good GP should already know enough to treat their condition.
Older patients and those with a regular GP are more likely to be pleased to see their GP consulting reference material than younger patients and those without a regular doctor, the survey shows.
WHAT PATIENTS SAY
Judy Tanner, 51, Bonbeach, Victoria.
“The GP I attend now doesn’t use a computer during the consultation. She writes notes by hand, which is more friendly because she talks to me and there is not the barrier of a machine. The GP I went to previously did use a computer and was quite condescending. He acted as if I must be some sort of idiot who wouldn’t know how to use a computer, even though I use computers for my work all the time. I felt he used it as a barrier, which you don’t appreciate when you are feeling ill and vulnerable.”
Denise Jenner Dennis, 37, Austinmer, NSW.
”if the doctor is interested and analytical in using the computer during the consultation, it can be useful to report, diagnose or prescribe, and I have experienced that. My GP is reasonably competent on the computer. However, I have seen GPs who can’t operate their computer well and are more interested in trying to get it to work properly for them, and that’s detrimental to the consultation.”
Kim Griffiths, 37, Sydney.
“My GP uses a computer during the consultation, and is competent at using it. I feel it adds to the consultation because they may go through and check more things than they would if they were using hand-written notes. The GP has never shown me what’s on the screen.”
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