Bedside Manner in the Days of Electronic Health Records

One of my first supervising physicians was notorious for his poor bedside manner, especially as it related to the computer.  A story frequently told when he was away from the clinic went like this:  One day, this particular physician was treating a patient.  He was supposedly documenting in an electronic health record on his laptop as the patient was describing his symptoms.  The patient could tell he was not paying attention to his medical problems so he stood up, walked behind the physician and caught him in the act of writing an e-mail.  Although appalling, I think this type of behavior may be all too common.  Electronics are distracting and impersonal.  When introducing electronic health records (EHR) into medical practices, how can healthcare providers overcome these obstacles?

American Medical News reports that Kaiser Permanente, a managed healthcare company has designed an acronym to help medical providers use electronic health records while maintaining proper bedside manner.  The acronym "LEVEL" offers some useful tips in creating a successful patient visit while simultaneously completing your electronic documentation. 

L- Let the Patient Look On

Setting your exam room up in such a way that puts you, the patient and the computer screen in more of a triangle format rather than keeping the computer between you and the patient so your patient is able to observe what you are doing.  This allows you to easily share what is on the screen with your patients and reassures your patient that you are paying attention and are on-task. 

E- Eye Contact

Patient visits should be conversations.  Treat your patient encounters as importantly as you would conversations with friends and family.  Looking up from your screen or taking a pause in your charting reassures the patient you are actively listening to what they have to say. 

V- Value the Computer

In reality, EHR does make our lives easier.  We can easily compare a patient's new lab results to their prior tests and send prescriptions straight to the pharmacy.  Share these benefits with your patients so they are able to see the value in the computer as well.  If you are frustrated with the EHR, your patients will be too.  Maintaining a positive attitude toward this change in medicine will convey the benefits of EHR to your patients. 

E-Explain What You Are Doing

Talking through the steps of your charting reassures the patient you are in fact working on their medical record not checking your e-mail.  Let the patient know what you are doing by saying things like "I am looking up your cholesterol levels from last year" or "I am sending your prescription to the pharmacy".  This assures your patients you are on track. 

L- Log Off

A major concern of EHR is patient privacy.  Log out of the patient's record in the exam room so they know you are not wheeling your laptop cart around the clinic with their pap results still displayed once you leave the room.

Do you have any opinions on the transition to EHR and how it affects your relationships with patients?  Share here!

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