Enhancing patient-doctor-computer communication in primary care: towards measurement construction

Abstract

ObjectiveThe traditional dyadic dynamics of the medical encounter has been altered into a triadic relationship by introducing the computer into the examination room. This study defines Patient-Doctor-Computer Communication (PDCC) as a new construct and provides an initial validation process of an instrument for assessing PDCC in the computerized exam room: the e-SEGUE.Material and methodsBased on the existing literature, a new construct, PDCC, is defined as the physician’s ability to provide patient-centered care while using the computer during the medical encounter. This study elucidates 27 PDCC-related behaviors from the relevant literature and state of the art models of PDCC. These were embedded in the SEGUE communication assessment framework to form the e-SEGUE, a communication skills assessment tool that integrates computer-related communication skills. Based on Mackenzie et al.’s methodological approach of measurement construction, we conducted a two-phased content validity analysis by a general and expert panels of the PDCC behaviors represented in the e-SEGUE. This study was carried out in an environment where EMR use is universal and fully integrated in the physicians’ workflow.ResultsThe panels consisted of medical students, residents, primary care physicians, healthcare leaders and faculty of medicine members, who rated and provided input regarding the 27 behaviors. Overall, results show high level of agreement with 23 PDCC-related behaviors.ConclusionThe PDCC instrument developed in this study, the e-SEGUE, fared well in a rigorous, albeit initial, validation process has a unique potential for training and enhancing patient-doctor communication (PDC) in the computerized examination room pending further development.

Implications of artificial intelligence for medical education

“…8 Take the role of communicator, and the fact that the traditional physician-patient encounter has "been altered into a triadic relationship by introducing the computer into the examination room". 9 Physicians need to acknowledge the large variety of patients' responses to big data and AI-supported objects, including concerns regarding privacy, disempowerment, and a lack of desire to know everything As a collaborator, physicians should be taught to accept and build on the fact that health AI technology and the wider accessibility of knowledge empowers some other health professions (eg, psychologists, physiotherapists, and nurses), as well as patients themselves, questioning physicians' previous status as holders of exclusive knowledge.…”

Improving Patient–Provider Communication and Therapeutic Practice Through Better Integration of Electronic Health Records in the Exam Room: A Pilot Study

“…New validated instruments to measure patient perception of providers’ communication practices have been developed since the time of our study that should be incorporated into future work (M. A. Alkureishi et al, 2018; Assis-Hassid, Reychav, Heart, Pliskin, & Reis, 2015). Furthermore, qualitative inquiry from patients regarding their perspective of communication and counseling behaviors during the clinical encounter may provide more robust insight into how the EHR-PACE intervention translates to improved patient-centeredness compared with close-ended survey items.…”

“…New validated measures have been developed since the launch of our study that should be incorporated into future work to better assess both provider and patient perception of EHR-communication behaviors (M. A. Alkureishi et al, 2018; Assis-Hassid et al, 2015). Providers also completed self-evaluation reflective of all patient encounters.…”

Medical Technologies Past and Present: How History Helps to Understand the Digital Era

“…From the perspective of patients, other concerns related to EHRs are more relevant, among them the safety of personal health data. But while notions of privacy -who has control over the data, who owns the patient history -are important for patients, a number of studies also show that patients perceive the careful digital documentation of their case as something positive (Assis-Hassid et al 2015;Sobral, Rosenbaum and Figueiredo-Braga 2015). 'Forced to choose between having the right technical answer and a more human interaction, [patients] picked having the right technical answer,' reports Gawande (2018; see also Hammack-Aviran et al, 2020).…”