Using a computer during the consultation

There is a wealth of experience from general practice about the effects of using a computer when consulting with a patient. Common complaints regarding the use of computers during a consultation is that clinicians appear disinterested, make little eye contact with the patient, and spend much of the consultation staring at their computer.

It is important to avoid this and develop strategies to give patients full attention for significant periods of time. The following tips suggest ways of developing a rapport with the patient during the consultation and avoiding misunderstandings and errors.

• 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
• Explain to the patient why the computer is being used during the consultation. Patients will be familiar with staff at their GP practice making records but may not yet expect it at their pharmacy
• Explain what you are doing and why. A patient is far less likely to feel disregarded if you make it clear why you are turning to use the computer
• Tell the patient that you will need to type information into the computer periodically, and that when you are doing this you will need to pause the conversation because you are not able to fully take in any information that the patient might give you
• Make it clear to the patient when you are going to transfer your attention to the keyboard and screen. You could signpost this by saying something like: “Hold on a minute, I just need to get that down on the computer” or “I need to concentrate on the computer for a minute”
• If you need to look at the screen to follow a clinical pathway and enter answers to questions, explain this to the patient
• Sometimes you might need to look for an answer to a clinical question while the patient is present. Explain that you are doing this to ensure that the patient gets the most up-to-date information. Make it clear you are using an accredited resource such as the BNF or NICE guidelines, rather than the patient assume you are using generic search engines to find out something you should know already
• You may need to consider sharing your screen with a patient and think how best to do this (it is generally considered good practice). The consultation room may need to be reconfigured. When showing patients information, check they can read it clearly and allow them enough time to read it without interruption
• Be aware of what your screen is displaying after each consultation. It does not necessarily have to display clinical notes to breach confidentiality; a clinic list with patient names or guidelines on a condition left on the computer would count as a breach. Clearing this data is often neglected and is a common error.