You went to school to become a physician.
I didn't have to go to school to become a patient.
But as a patient with several chronic diseases, I feel I am getting an education in doctor-patient relations. It isn't pretty.
A new trend I have observed in the examining room of a few -- though not most -- of the health practitioners I see is they're not looking me in the eye. It's actually disturbing when you talk to an expert about big things impacting your well-being and they're focused on a computer screen.
I feel like screaming: "Hey doc, I'm over here!"
Small gestures can make or break a physician-patient encounter. Many physicians may have an in-born knack for good communications or they observe in their training how it's done well -- or not -- by their medical school profs and mentors.
There's the tone of the voice. There's the healing touch, just a pat on the patient's back or hand. And finally, there is the therapeutic gaze -- making eye contact.
These subtle forms of communications help the doctor make his or her points, communicate what's going on with the patient's health and what can be done about it.
But some doctors don't look me in the eye anymore. Rather, they are focused on their laptop screen and keyboard as they fill out my electronic medical record in real time.
Here's a recent example.
I traveled a long distance to see a specialist, who I previously had visited three years ago. I noticed then how intently this doctor stared at his computer and not me.
He conveyed a sense of being distracted. As a patient, I felt something was taking the doctor's attention off me and onto a computer screen.
I found it frustrating at the time, but I had forgotten about it. I got a quick reminder.
This time, I was rushed. I stopped off at an ATM machine in the medical office building and the machine ate my checks and debit card without confirming my deposit. I barely made it to the doctor's office in time.
I again experienced a doctor focused on the screen, not me. Was he checking email or a Facebook or Twitter account? Was he filling out a checklist list in a medical record? I couldn't tell.
When I finished, I went to my car and called my bank to straighten out the ATM issue. While I was on hold, about 15 minutes after I left the doctor's office, I got an email notification that the record of my doctor contact had been posted in his patient portal. Very efficient, but not a satisfying doctor encounter.
I had a similar experience with another physician staring at his screen as he filled out the patient record. I called him on it. He apologized and explained what he was doing.
Are patients getting less than ideal care because doctors are slaves to computer screens, keyboards and EMRs?
Through Google, I found Enid Montague, PhD, a professor at the College of Computing and Digital Media at DePaul University in Chicago, with a background in industrial engineering. She researches the design and evaluation of clinical and consumer health technologies.
[Ironic confession: I didn't see Montague in person or talk to her on the phone. She filled me in on her work via email.]
I asked her why she studies eye contact. "It's a good objective indicator of where a person is placing their attention. Gaze between two people is eye contact, and that is a very important aspect of interpersonal relationships, rapport and trust," Montague explained.
"Too much gaze at an interface, like a computer, can indicate that the needed information is not well designed or difficult to find. Too little gaze can mean that the information wasn't fully processed, so the goal is to design for appropriate amounts of gaze. So gaze helps me understand which aspects of doctor-patient-computer relationship need improvement."
She said there have been few studies -- mainly relying on subjective self-reporting -- on the amount of time doctors spend looking at patients.
The industrial engineer said medical students generally are taught to develop rapport and nonverbal communication skills. "The challenge is that they aren't usually taught rapport skills when they are taught to use electronic health records, and EHRs vary from vendor to vendor. So many doctors are left to figure out how to communicate using a computer on their own," she said.
I could sense my doctors' frustration in dealing with the computer and me simultaneously. It might have helped if the doctor explained what was going on, even made a joke about these damn computers.
It is clear that the introduction of the "computer interface" is impacting the doctor-patient relationship.
Montague said there is also a growing body of literature that indicates computers in patient care may be leading to physician burnout and high turnover rate.
Also, it is alarming, she said, that there is evidence that "poor nonverbal communication can lead to less rapport, less trust, and patients leaving practice."
She added that may not hold true over time "as people are generally more accepting of computers and technologies being used in medicine. Having reliable access to patient information via computers has many benefits to patients, but improvements are needed to optimize how patient care is provided and to ensure that physicians' extra cognitive work to find and input information doesn't leave them less able to understand patient concerns and [find] solutions."
Maybe technology can solve this technology problem?
Maybe AI software can enable systems to fill out medical records based on the patient-doctor conversation in real time, allowing doctors to maintain his or her healing gaze with the patient?
Let's heal the patient-doctor-computer interface for the good of us all. Put patients first, before a computer screen.