In Age of EHRs, Patients Prefer Face-to-Face Communication

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When presented with different options, patients perceived physicians that communicated face to face without the use of a computer as being more compassionate, professional, and as having better communication skills, according to the results of a study (abstract 26) presented ahead of the 2017 Palliative and Supportive Care in Oncology Symposium, held October 27–28 in San Diego.

The results were presented by Ali Haider, MD, assistant professor at the University of Texas MD Anderson Cancer Center in the department of palliative, rehabilitation, and integrative medicine.

According to Haider, many physicians now use a computer software program for managing electronic health records.

“As of 2015, nearly nine in 10 office-based physicians have adopted some form of electronic health record, and since 2008, the rate of adoption has tripled,” Haider said. Although studies have shown that electronic health records are effective in managing patient data, billing processes, and record keeping, studies on patient–doctor communication have also demonstrated their association with less face-to-face interactions and eye contact, according to Haider.

The researchers were concerned that computer use might affect communication with patients, and knew from earlier research that people with chronic health concerns, and often accompanying emotional issues, want their doctors to talk to them directly.

They conducted the study at an outpatient supportive care center. It included 120 English-speaking adults with advanced cancer who were randomly assigned to watch two standardized, 2-minute video vignettes of a physician–patient encounter.

The researchers filmed four videos that featured actors who were carefully scripted and used the same gestures, expressions, and other nonverbal communication in each video to minimize bias:

• Video 1: Doctor A in a face-to-face consultation with just a notepad in hand

• Video 2: Doctor A in a consultation using a computer

• Video 3: Doctor B in a face-to-face consultation with just a notepad in hand

• Video 4: Doctor B in a consultation using a computer

After viewing their first video, the patients completed a validated questionnaire rating the doctor’s communication skills, professionalism, and compassion. Subsequently, each group was assigned to a video topic (face-to-face or computer) they had not viewed previously featuring an actor–doctor they had not viewed in the first video. A follow-up questionnaire was given after this round of viewing, and the patients were also asked to rate their overall physician preference.

After round one, patients rated physicians in the face-to-face video as having more compassion and better communication skills and professionalism than the physicians in the videos where a computer was used in the exam room. After watching both videos, almost three-quarters (72%) of patients preferred the face-to-face interaction.

“This study gives us the message that patients would prefer their doctors to give them undivided attention,” Haider said. “Better communication can enhance patient trust and satisfaction.”

Commenting on the results of the study American Society of Clinical Oncology (ASCO) expert, Andrew S. Epstein, MD, said, “In the age of ubiquitous technology this study is an important reminder of the need to address potential for technology to interfere with the patient–clinician interface, which is a critical component of the relationship between these two parties. While I agree that more research is needed, face-to-face communication seems the preferred route despite the pressure that all clinicians have to search and document within the medical record.”