Effects of Exam-Room Computing on Clinician–Patient Communication: A Longitudinal Qualitative Study

. 2005 Aug;20(8):677–682. doi: 10.1111/j.1525-1497.2005.0163.x

Period 2	Period 2
Spatial organization inhibits communication: In this visit, another study clinician sits in front of the computer screen. Instead of tilting the screen toward the patient, the clinician positions it so that it is out of the patient's view. While discussing aspects of the patient's care, the clinician remains focused on the computer screen. During this episode, lasting several minutes, the clinician's eyes never leave the computer screen. At one point, the patient attempts to see the computer screen by leaning out from the exam table, almost falls off, and finally gives up (Fig. 1)	Spatial organization facilitates communication: The computer rests on the wall next to the foot of the exam table in this visit. During the clinician's computer use, the patient is able to watch the screen. At one point, the clinician pauses, turns the screen closer to the patient, and points to a section of the electronic record to discuss a recent test result. During the entire visit, the clinician is either standing right in front of the patient looking at her when talking, or turns slightly to the computer to type. When she is typing, it is very easy for her to pivot her head to look at the patient. The clinician and the patient also sit close to each other (Fig. 2)

Period 2

Spatial organization inhibits communication: In this visit, another study clinician sits in front of the computer screen. Instead of tilting the screen toward the patient, the clinician positions it so that it is out of the patient's view. While discussing aspects of the patient's care, the clinician remains focused on the computer screen. During this episode, lasting several minutes, the clinician's eyes never leave the computer screen. At one point, the patient attempts to see the computer screen by leaning out from the exam table, almost falls off, and finally gives up (Fig. 1)

Spatial organization facilitates communication: The computer rests on the wall next to the foot of the exam table in this visit. During the clinician's computer use, the patient is able to watch the screen. At one point, the clinician pauses, turns the screen closer to the patient, and points to a section of the electronic record to discuss a recent test result. During the entire visit, the clinician is either standing right in front of the patient looking at her when talking, or turns slightly to the computer to type. When she is typing, it is very easy for her to pivot her head to look at the patient. The clinician and the patient also sit close to each other (Fig. 2)