Effects of exam-room computing on clinician-patient communication
Effects of exam-room computing on clinician-patient communication
复制标题
DOI：
10.1111/j.1525-1497.2005.0163.x
复制
发表时间：
2005-08-01
影响因子：
5.7
通讯作者：
Hsu, J
中科院分区：
文献类型：
--
作者：
Frankel, R;Altschuler, A;Hsu, J
目的：评估检查室计算机对临床医生和患者之间沟通的影响。设计和方法：使用 3 个时间点的定期就诊录像进行纵向、定性研究：将计算机引入检查室之前 1 个月、之后 1 个月和之后 7 个月。地点：大型综合医疗服务系统中的初级保健诊所。参与者：9 名临床医生（6 名医生、2 名医生助理和 1 名执业护士）和 54 名患者。结果：将计算机引入检查室影响了临床医生和患者之间的视觉、语言和姿势联系。计算机影响的大小和方向在每次访问中都存在差异。我们确定了考场计算影响临床医患沟通的 4 个领域：就诊组织、言语和非言语行为、计算机导航和掌握以及考场的空间组织。我们在所有 4 个领域观察到一系列对临床医患沟通的促进和抑制作用。对于两个领域，访问组织以及语言和非语言行为，在计算机引入之前观察到的促进和抑制行为似乎在考场计算发生时被放大。同样，考场计算涉及导航和掌握技能以及考场的空间组织，这给沟通带来了挑战和机遇。在所有 4 个领域中，从引入到 7 个月的随访，检查室计算行为几乎没有观察到变化。结论：在门诊检查室有效使用计算机可能取决于临床医生的基本技能，这些技能的发展和放大对临床医患沟通的影响无论是积极还是消极。计算机使用行为在前 7 个月内似乎没有太大变化。对改善临床医生检查室计算机使用感兴趣的管理人员和教育工作者需要更好地了解临床医生的技能和以前与电子病历相关的工作习惯。还需要更多研究新技术对临床关系的影响。
OBJECTIVE: To evaluate the impact of exam-room computers on communication between clinicians and patients.DESIGN AND METHODS: Longitudinal, qualitative study using videotapes of regularly scheduled visits from 3 points in time: 1 month before, 1 month after, and 7 months after introduction of computers into the exam room.SETTING: Primary care medical clinic in a large integrated delivery system.PARTICIPANTS: Nine clinicians ( 6 physicians, 2 physician assistants, and 1 nurse practitioner) and 54 patients.RESULTS: The introduction of computers into the exam room affected the visual, verbal, and postural connection between clinicians and patients. There were variations across the visits in the magnitude and direction of the computer's effect. We identified 4 domains in which exam-room computing affected clinician-patient communication: visit organization, verbal and nonverbal behavior, computer navigation and mastery, and spatial organization of the exam room. We observed a range of facilitating and inhibiting effects on clinician-patient communication in all 4 domains. For 2 domains, visit organization and verbal and nonverbal behavior, facilitating and inhibiting behaviors observed prior to the introduction of the computer appeared to be amplified when exam-room computing occurred. Likewise, exam-room computing involving navigation and mastery skills and spatial organization of the exam-room created communication challenges and opportunities. In all 4 domains, there was little change observed in exam-room computing behaviors from the point of introduction to 7-month follow-up.CONCLUSIONS: Effective use of computers in the outpatient exam room may be dependent upon clinicians' baseline skills that are carried forward and are amplified, positively or negatively, in their effects on clinician-patient communication. Computer use behaviors do not appear to change much over the first 7 months. Administrators and educators interested in improving exam-room computer use by clinicians need to better understand clinician skills and previous work habits associated with electronic medical records. More study of the effects of new technologies on the clinical relationship is also needed.