To compute or not to compute in front of patients, that is the EMR question.

Rarely do I become accosted by a patient with a preconceived notion that doctors should not be using computers, at least not in front of patients.  However, I’ve had at least two instances in my recall in which patients told me they were not being paid enough attention.  I find that these patients are usually what most professionals would refer to as “special”  and that this usually manifests itself in some aspect of the visit or later.

About two years ago, I recall a young, approximately 30 year old gentleman who never said anything out of the ordinary during our initial visit but later on the phone told me that I had rudely “shushed” him during our visit and that I had also said to him a whole cadre of other bizarre things that I don’t recall ever saying to any patient.  When I spoke to him on the phone about why he had not completed any of the recommended testing, my blood ran a bit cold and I seriously wondered if he was an undiagnosed schizophrenic person who had heard bizarre voices and supposed that those were mine.  To this day, I remain in question of it.

A few weeks go, a 60 year-old woman whom I saw suddenly lit into me, mid interview, when I was typing in her responses while talking with her across my desk.  My face was admittedly not on hers at that exact moment but at an angle of about 30 degrees off.  “You know I have to say this is the second time this week that I have been to see a doctor where the doctor’s face is on the computer and not mine.  Frankly, I find it very disconcerting!”  Of course, I apologized and immediately turned to her and said, “It’s okay, how about we just talk like this?”  I finished the interview professionally and felt that she was safe to follow up with her primary doctor since only an explanation of her mild lab abnormalities was necessary.  During the rest of our visit, she told me that she was not fond of doctors at all lately since they weren’t doing her any good, just reassuring her that her conditions could be monitored periodically without treatment.  I seriously looked at her with raised eyebrows and put it back on her a bit, asking, “Do you really want me to tell you something is seriously wrong with you?”  She finally broke a grin and chuckled (as I briefly thought about kicking her out of my fourth floor window).  Normally, I would have offered to follow her for an annual visit, but under the circumstances, I felt it would have been more pleasant for both of us if I didn’t see her again.  As she checked out and said she hoped I wouldn’t hold her comments against her, I smiled and said that this was becoming the norm and she should not be surprised if all of her visits eventually came to this.

Luckily, these examples are very rare.  One patient recently wrote about her negative experience with EHR charting at the time of the visit in one of my favorite magazines, Physicians Practice.  I would hope that patients understand that computers are here to stay, and I’m not going to hold off on documenting all of their related medical notes until after they’ve left.  But I do try to at least face patients during our visits.  My computer is in my office, where I conduct interviews, and not in the exam room, where I am only examining patients.  I already spend far too much time calling people back, sending in scrips and filling out paperwork outside of my normal office hours.  To add extra time in this area of routine documentation during nights and weekends would not be time well spent.

About the author

Dr. Michael West

Dr. Michael West

Dr. West is an endocrinologist in private practice in Washington, DC. He completed fellowship training in Endocrinology and Metabolism at the Johns Hopkins University School of Medicine. Dr. West opened The Washington Endocrine Clinic, PLLC in 2009. He can be contacted at


  • Dear Dr. West,

    the problem you’re describing is too often ignored by clinical physician. Most of the patients even do not complain directly. Like a TV device, a computer display interrupts the eye communication between patient and physician in a very rough way. Much more than a paper based document did before (although I’ve seen drastic cases of mishandling here). To the patient, it loks like the physician is hiding behind the device and the patient is just downgraded to become kind of an add on to the situation. Since the patient physician relationship has some very deeply emotional aspects, this is about to introduce some severe interferences. My advice to the collegues would be to never put the device as a barrier between the patient and the physician. In some cases I even do not sit behind my desk, but directly in front of my patient. I return to the desks and the gadets at the earliest when the primary exam or dialogue is completed. I never read papers in front of the patient unless he himself presented them to me. I also do the preparations before he enters and the documentations after he left. Many IT pro’s simply forget, that the patient is not here for the IT but the IT should be there for the patient. Basically it would help to have some flatscreen hidden in the surface of the desk, so it woud appear to the patient somewhat like the paper on the desk and does not interrupt the physical contact, but I don’t know any verndor to provide such furniture. Anyway, the doctor is in charge to make clear, that he is with the patient using the computer and not with the computer using the patient.

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