The following is the second in a series from Mike Moore

- Mike Moore

For those who have children not yet six years old, I’m going to let you in on a secret.  There will come a time when much of your adult conversation will take place on the sidelines... at the soccer field, baseball diamond, fencing salle, or at dance lessons.  Such was the case a few weeks ago when I ran into some old friends.

The occasion was the first soccer game for my young daughter.  I ran into another parent who I had last seen at a soccer game for my youngest son- at least 4 years ago.  Her husband is a professor at a seminary.  He knew of a colleague who uses a Tablet PC in his teaching, but was not acquainted with it himself.  We discussed the phenomenon of students and their laptops in class, the instructor seeing the backs of computer screens rather than the faces of students.  At first I thought this a bit unfair, as I had no computer screen to hide behind when I was a student.  Closed eyelids or a dazed look were obvious to see in those days.  I still remember with fondness the time in organic chemistry when I awoke to a quiet voice asking me, “Where ya going, Mikey?” with my head drooped forward and my nose about one inch above the desktop.

But then I realized that screens really offer little protection, as a dozing student now appears to be a laptop computer sitting on the torso of a human body, and the silence of inactive computer keys must be deafening at times.

I had not expected her comments, however.  ”The last time I was at the doctor’s office with the kids they were using a computerized system.  I understand what they were doing, but it seemed a little strange when they spent most of the time looking down at the keyboard instead of at me.”  Clearly they were not using Tablets.  Having a PhD herself, computers per se were not a distraction.  This issue of computers interfering with the doctor patient relationship has received attention elsewhere both here and here.  

At the risk of “making a mountain out a mole hill”, I’m about to make a mountain out of something.  (Rant Warning)

Didn’t our parents teach us when we were very young, “Look at me when I’m talking to you”? For those of us who are doctors, we were taught, “It is well known that the interviewer may learn more about the patient from the way in which the patient tells a story than from the story itself.”*  “The interviewer should sit in a chair directly facing the patient in order to make good eye contact.”   “It is poor form to write extensive notes during the interview. Attention should be focused more on what the person is saying and less on the written word.  In addition, by taking notes, the interviewer cannot observe the facial expressions and body language that are so important to the patient’s story.”

By embracing and implementing technology that inhibits our interaction with patients, we are making business practice the priority over the practice of the healing profession.  Not only is this compromising our oath as physicians to care for our patients, but in the long run it is probably poor business practice as well!  “Most malpractice litigation is the result of a deterioration of the traditional doctor-patient relationship rather than the result of true medical negligence.” 

I am sure there are physicians who are skilled at maintaining adequate eye contact and rapport with patients while typing, but I bet the majority of us would prefer writing on a Tablet PC.  It is only a derivation of what we are accustomed to, not a major change.  There is a problem when the patient thinks the doctor is more focused on data input than listening to his/her concerns, and an even bigger problem when the doctor actually is more focused on data input than listening, even if unintentional.

*Quotations from: Textbook of Physical Diagnosis; History and Examination- 2nd Ed./Mark H. Schwartz, 1994, pp. 5-8.