How Digital Technology is Reshaping Doctor-Patient Communication

The practice of medicine has come a long way from the days when doctors used to rely solely on their knowledge, clinical experience, and pen and paper. With the rapid advancement of digital technology, computer-mediated medical practices have become the norm in modern healthcare settings. From electronic medical records (EMRs) to telemedicine, technology has revolutionized how doctors and patients interact and communicate.

However, as a recent mini-review by Marino et al. (2023) highlights, this transition to a technology-driven medical landscape raises crucial questions about ensuring effective and patient-centered communication during medical visits.

The Importance of Patient-Centered Communication

Before we get too deep into the impact of technology, let's briefly touch upon the significance of patient-centered communication (PCC). As Marino et al. (2023) explain, PCC encompasses four key elements: empathy, active involvement, active listening, and clear and understandable communication.

Numerous studies have demonstrated the positive effects of PCC on patient satisfaction, well-being, and health outcomes (Kuipers et al., 2019; McDonagh et al., 2004; Ong et al., 2000).

The Double-Edged Sword of Technology

While technology offers several benefits, such as quick access to clinical information and reduced medical errors (Devin et al., 2020; Rouayroux et al., 2019), its impact on doctor-patient communication is a double-edged sword. Studies have shown that the use of computers during consultations can adversely affect PCC by increasing the risk of physicians not listening carefully or answering patients' questions (Crampton et al., 2016).

Ethnographic and conversational studies have shed light on how computers have become "important communicative actors" during medical visits (Pearce et al., 2008). Patients often have to synchronize their speech and gaze with the doctor's computer-related activities, leading to longer pauses, abrupt topic changes, and shorter responses from the physician (Newman et al., 2010).

The EMR Conundrum

The use of EMRs has further complicated the doctor-patient dynamic. As Marino et al. (2023) note, the transition from paper to digital records is not just a simple transfer but a shift in how medical work is represented and documented. Studies have reported that physicians exhibit potentially negative communicative practices when using EMRs, such as interrupting conversations, increased gaze shifting, and a low frequency of screen sharing with patients (Alkureishi et al., 2016; Swinglehurst et al., 2011).

Interestingly, research has also highlighted the positive impact of traditional pen-and-paper literacy practices on PCC. Sterponi et al. (2017) found that these "slow" analog practices enable doctors to engage with patients while simultaneously performing complex activities like diagnostic reasoning and decision-making.

Striking a Balance

So, how might we reset the doctor-patient relationship based on these findings? Marino et al. (2023) outline three key considerations:

1. Promote a shared and transparent use of technology, making the screen visible to patients and explaining what the clinician is doing on the computer.
2. Integrate analog and digital tools, using the strengths of both to enhance patient participation and understanding.
3. Redesign the user experience of existing technologies like EMRs to become more patient-centric, relieving physicians from administrative tasks that burden clinical interactions.

Embracing innovations like voice recognition and AI could free up time and space for more effective PCC. We're already seeing this in some practices, with many more piloting or discussing it. EMRs are certainly due for innovation (Detmer and Gettinger, 2023).

While digital technology undoubtedly offers numerous benefits in healthcare, it should enhance, rather than hinder, the doctor-patient relationship and communication. Staying patient-centered and integrating the best of both analog and digital experiences, we can create a future where technology serves as a facilitator, rather than a barrier, to quality medical care.