Computers offer many benefits to patient interactions, including:

allowing clinicians to access patient specific information
reviewing relevant guidelines
showing patients health education material
communicating with other staff
recording information in a comprehensive and timely manner.

But while computers can enhance healthcare interactions for both patients and clinicians, they can also present challenges if not incorporated into medical practice effectively.

Below are a few common queries that illustrate the pitfalls of using computers in consultations.

A complaint about communication

A GP reviewed an elderly patient with known COPD who was accompanied by her daughter. She reported a three-month history of a chesty cough with some shortness of breath, similar to the symptoms experienced when she had an infective exacerbation of her COPD. The GP took a detailed history, assessed her, prescribed a course of antibiotics and provided safety netting advice.

Several months later, the patient was referred for an X-ray and subsequently diagnosed with lung cancer after being reviewed by other GPs for presumed exacerbation of COPD. Her daughter, with the patient’s consent, wrote a complaint about many aspects of her care mainly focused on the alleged delayed diagnosis of lung cancer. However, the complaint about the first GP was that they had appeared disinterested in her mother and spent all their time staring at the computer screen rather than at her. The suggestion was that had the GP paid more attention to her and been less dismissive, they may have picked up her diagnosis earlier.

The response

Fortunately, the GP's notes demonstrated that they had been thorough in their assessment of the patient and reflected that they had reviewed her previous notes as part of this. The GP contributed to the overarching response by the practice to explain that they had been checking her medical history, including details such as when she last had an exacerbation, what antibiotics she had received before, and the results of any sputum cultures. They would also have looked at the computer to generate the prescription, check for allergies and record what she was saying. The GP concluded that this had all been done to ensure she received safe and appropriate care, but in hindsight, appreciated that it could have given the impression they were not listening to her.

One of the most common complaints regarding the use of computers during consultations that we see, either as a standalone grievance or as part of a wider complaint, is that the doctor was disinterested, made no eye contact with the patient and spent the entire consultation staring at their computer.

An inadvertent confidentiality breach

A newly pregnant woman was attending an antenatal appointment at her GP practice. After being called in, she sat down and noticed the computer screen was angled towards her enough that she could see a list of the names of the other women attending the clinic including the distinctive name of an old school friend. The midwife turned the screen back towards her and the consultation concluded without event.

A week later the practice received a complaint from the other woman on the list who was furious that her social circle had learned she was pregnant before her own family after the first patient had mentioned to seeing her name on the antenatal clinic list to some mutual friends.

The response

Alongside assistance from the MDU, the practice responded with input from the midwife who explained that they would have angled the screen to show the last patient a medical diagram and then turned it back but clearly not enough on this occasion. The letter included an apology and confirmation that valuable lessons had been learnt in relation to being careful about what information is displayed on screen when patients are in the room and the importance of the screen position relative to patients. They were also advised to hold a significant event audit meeting about the incident and consider their obligations to inform the ICO of data breaches.

Data breaches are a relatively common in healthcare and come in various guises. You can find out more about how to respond when these occur here.

The doctor needed to use an internet search to tell them what to do

A GP consulted a female patient with a BMI of 36 who was seeking the oral contraceptive pill. Although the consultation started well, the patient was offended when the GP mentioned having to consider the patient’s weight when deciding on the best option. The GP explained that they would need to check online to determine the most appropriate prescription, which they did.

After the GP had furthered counselled the patient on the risks versus benefits of treatment and prescribed the agreed medication, the patient left. On her way out she loudly told the receptionist and waiting patients that the GP clearly had no clue what she was doing as she had needed to Google her treatment and questioned her training.

The response

The GP called the patient later the same day to discuss her concerns and behaviour. The doctor explained that they had been referring to the UKMEC site rather than Google in order to be able to fully counsel the patient on the prescription. She reassured the patient that this was not done because she ‘had no clue what she was doing’ but rather because she had the appropriate knowledge to recognise potential dangers associated with the patient’s request and knew where to look for authoritative guidance.

The GP also highlighted that if she had concerns about the care provided it was appropriate to use the practice’s complaint process rather than question if a doctor was properly trained in front of the entire waiting room. The doctor explained how it was not only offensive to them personally and professionally, but it also could cause concern to other patients.

The patient apologised for what she considered had been a throwaway remark and confirmed that she did not wish to make a formal written complaint.

As the verbal complaint had been resolved within 24 hours, the practice decided a response letter was not necessary. However, they did make a log of the incident and resolution in the practice’s complaint folder. A note was also put on the system, at the doctor’s request, that where possible the patient would not be booked in with that GP again.

The GP planned to discuss the issue at their appraisal and reflected that in future they would tell patients what they were checking and where and why to avoid any misunderstandings. They would also consider showing the screen to patients when appropriate so they could see the relevant resources.

Top tips for using computers during consultations

First impressions count. If possible, face the patient when they first come in and maintain eye contact for the initial part of the consultation rather than already being positioned facing the computer. A 2001 study demonstrated the importance of the doctor's body position at the beginning of a consultation in affecting patient fluency. A starting position of the lower body facing the computer, rather than the patient, had a negative effect, even if the doctor provided eye contact by intermittently turning their upper body to look at the patient.
Tailor computer use to the patient and problem presenting to you. A patient who can clearly communicate about a minor ailment is less likely to be adversely affected by lack of eye contact than a patient who is struggling to convey their symptoms related to mental health concerns or complex health issues.
Explain what you are doing and why. A patient is far less likely to feel disregarded if you signpost why you are turning to use the computer. A brief, ‘I’m just going to have a look at your records to check a few details, but I am listening’ can go a long way to reassure the patient that the computer use is intended to support their care rather than distract from it.
If you do need to concentrate and are concerned that you might miss something, it is far better to be clear about this and ask the patient to pause for a moment. Being explicit that this is because you want to make sure you don’t miss anything reduces the chance that they'll feel disregarded by being asked to be quiet for a moment.
When using the computer to review relevant guidelines, it can avoid misunderstandings if you are clear that you're checking something in the BNF or formal referral pathways rather than the patient assuming you are using generic search engines to find out something they feel a doctor should know.
Be aware of what your screen is displaying after each consultation. It does not necessarily have to be a patient’s visible medical notes to breach confidentiality. A clinic list with patient names or guidelines on a condition left on the computer are enough to breach confidentiality.
When showing patients information on your screen, check the patient can read it clearly and give them time to read it without interruption. Check they have understood the text and whether they have questions. Once they have finished, turn the screen back towards you fully and close the browser window with the health information on. This reduces the chance that the subsequent patient will be able to ascertain what the last patient was seeing you about.

Computers and consultations

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