November 13, 2018
Doctors\
Be Well

Doctors' Computer Work Prevents Eye Contact With Patients

by John Swartzberg, M.D.  

While we go to doctors (and other health care providers) to be treated for what ails us and to get guidance about how to stay healthy, developing a trusting therapeutic relationship is an important result of such visits. A large part of this relationship depends not on facts and words and treatments, but on empathy. In the old days, this was called good bedside manner.

To be sure, the right words and tone help doctors communicate that they care and help establish trust, but so do things like physical touch and even eye contact. We’re taught about nonverbal communication skills in medical school, but not enough, and modern medical “management systems” seem to conspire to put a wall between doctors and patients.

Research shows that the simple touch of a caring doctor or other health care provider as part of the physical examination can itself help make patients feel better. Many medical visits are just consultations, however, and are solely for talking, so there may be no physical contact.

But what if your doctor hardly ever makes eye contact during your visit? I suspect you’d feel shortchanged, especially when you are discussing important matters. It may feel like you aren’t even in the room together. Unfortunately, this has been happening more often in recent years because doctors’ eyes are increasingly glued to their computer screens and keyboards as they fill in required electronic medical records (EMRs). I’ve heard many people complain about this.

I stopped seeing patients about 10 years ago, when EMRs were in their infancy. I know that they can make medical care better, safer, and more efficient, ensure that preventive services are up to date and that vital checklists get filled out, and allow medical teams to share data about patients. I also know that EMRs frustrate doctors because of all the time-consuming clerical work—and because computers in the exam room get in the way of communication with patients.

This was confirmed by a study in JAMA Oncologyin June 2018, in which 120 people were shown two videos of a medical consultation, one portraying a face-to-face visit, the other showing a doctor using a computerduring the visit. Not surprisingly, people rated the doctor in the face-to-face scenario as more compassionate, professional, and communicative.

I can’t imagine not looking patients in their eyes. It would be like doctoring blindfolded. You learn a lot from how people return your gaze, their expressions, gestures, and other body language. There truly is such a thing as a “therapeutic gaze,” which can inspire trust and hope in patients. Trust and hope, in turn, can help make therapies more effective. Doctors staring at screens can also send an unnerving signal that they are in thrall to a depersonalized medical bureaucracy (involving mandates by hospital systems, insurance companies, and the government), in which managers and administrators call the shots.

One solution is for doctors to have “scribes” who take care of the typing and perhaps even go through some of the preliminary checklists and record keeping. Such assistants cost money, and some patients may not like having an extra person in the room, but they can free up doctors’ time for patient contact. Instead of typing, some doctors dictate information into handheld recorders or smartphones, though that can also be distracting. Someday perhaps there will be artificial-intelligence software that fills out medical records while doctors and patients talk.

The doctor/patient relationship is in a transition from the old simpler days to a future in which computers will be fully and unobtrusively integrated into medical care. Few doctors or patients are happy with today’s evolving systems. Things will get better, but meanwhile we have to muddle through.

This article first appeared in the UC Berkeley Wellness Letter.

Also see Is Your Doctor Burned Out?