title: Computers in the exam room: differences in physician-patient interaction may be due to physician experience.
abstract: BACKGROUND
  The use of electronic medical records can improve the technical quality of care, but requires a computer in the exam room. This could adversely affect interpersonal aspects of care, particularly when physicians are inexperienced users of exam room computers.
  
  
  OBJECTIVE
  To determine whether physician experience modifies the impact of exam room computers on the physician-patient interaction.
  
  
  METHODS
  Cross-sectional surveys of patients and physicians.
  
  
  METHODS
  One hundred fifty five adults seen for scheduled visits by 11 faculty internists and 12 internal medicine residents in a VA primary care clinic.
  
  
  METHODS
  Physician and patient assessment of the effect of the computer on the clinical encounter.
  
  
  RESULTS
  Patients seeing residents, compared to those seeing faculty, were more likely to agree that the computer adversely affected the amount of time the physician spent talking to (34% vs 15%, P = 0.01), looking at (45% vs 24%, P = 0.02), and examining them (32% vs 13%, P = 0.009). Moreover, they were more likely to agree that the computer made the visit feel less personal (20% vs 5%, P = 0.017). Few patients thought the computer interfered with their relationship with their physicians (8% vs 8%). Residents were more likely than faculty to report these same adverse effects, but these differences were smaller and not statistically significant.
  
  
  CONCLUSIONS
  Patients seen by residents more often agreed that exam room computers decreased the amount of interpersonal contact. More research is needed to elucidate key tasks and behaviors that facilitate doctor-patient communication in such a setting.
authors.affiliation: Division of General Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA. roufe@umkc.edu
authors.forename: Emran
authors.initials: E
authors.lastname: Rouf
authors.forename: Jeff
authors.initials: J
authors.lastname: Whittle
authors.forename: Na
authors.initials: N
authors.lastname: Lu
authors.forename: Mark D
authors.initials: MD
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D001292:Attitude to Computers; D003142:Communication; D003430:Cross-Sectional Studies; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D016347:Medical Records Systems, Computerized; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D014768:Virginia