Enhancing Patient-Doctor-Computer Communication in Primary Care: The E-segue Measurement Construction

Effective patient-doctor communication (PDC) is known to have significant ramifications to the quality of medical care. As such, the PDC literature contains numerous models that describe the necessary communication skills and tasks required from physicians in order to establish effective communication with their patients. These models are primarily based on the patient-centered approach. However, they do not take into account the effects of electronic medical record (EMR) use which has become an important part of the medical encounter.

The computer has been known to alter the traditional dyadic patient-doctor relationship as it presents a source of potential distraction for the physician from the patient and various patient-centered behaviors such as: eye contact and attentiveness to the patient, while creating a cognitive overload for physicians during the encounter. We assert that the change in the PDC dynamics, caused by EMR use, requires reexamining the necessary skills and communication tasks for establishing effective PDC.

Surprisingly, literature on the direct effects of EMR use on PDC is scant. Nevertheless, some literature does highlight the different behavioral patterns of physicians during the medical encounter while using the computer. These behavioral patterns clearly demonstrate that the computer`s presence in the exam room actively alters physicians` patient-centered behaviors.. As such, certain behaviors were found to facilitate effective PDC, whereas others negatively affect PDC while compromising patient-centered aspects of the encounter. Thus, though not empirically evaluated, the literature offers different views of the necessary `ingredients` for establishing effective PDC in the computerized environment. These communication skills and tasks seem to be inherently different from the communication skills and tasks referred to in the PDC literature that do not take computer use into consideration. This notion has led us to question the appropriateness of existing physician communication skills assessment tools, as they disregard necessary communication skills and tasks required during the medical encounter while using the computer.  Recognizing this gap, our study methodologically develops and validates a new assessment tool aimed to evaluate the physician’s communication skills while using the computer. We define a new construct: patient-doctor-computer communication (PDCC), and generate 27 items that represent the construct based on a profound review of the literature. Following an initial content validation by two experts` panels, we test the remaining 22 items using inter-rater reliability based on 56 videotaped simulated medical encounters. The results yielded fair to high reliability of 70% of the items. Future research is called for further validation of the tool.

The newly developed assessment tool bears significant contribution for both research and practice. On the theoretical side, researchers are invited to further validate and enhance the tool to best reflect behaviors required to evaluate PDCC, an important construct shown to affect the quality of the medical encounter at the primary care clinic. On the practical aspect, this tool can be used for training and benchmarking physicians’ communication with patients during the medical encounter at the primary care clinic, while using the computer.