How do computers change the doctor-patient interaction? How do foods and beverages advertise to parents? This is Healthcare Triage News...

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I love information technology and I'm a huge believer in clinical decision support as a means to improve quality. But even I recognize that the use of computers, especially in the exam room, changes the doctor-patient interaction. When I'm seeing children in clinic, I almost never ever use a computer in the room. I check for alerts ahead of time, and I chart after. I want to appear engaged. But maybe that changes the quality of my care for the worse. Maybe other doctors use the computer a lot in the room to make sure that they miss nothing. 

A study just released in JAMA Internal Medicine looked at how computer use was associated with communication, and it was called "Association between Clinician Computer Use and Communication with Patients in Safety-net Clinics". Research assistants enrolled and interviewed patients by telephone before appointments. The subsequent visits were videotaped, and patients were interviewed again after the visit. Clinicians submitted data through questionnaires. Clinicians' computer use was measured on the following:
1.) Amount of review of computer data they did
2.) Amount of typing or clicking the computer mouse did
3.) Lack of eye contact made with patients
4.) Non-interactive pauses caused by computer use. 

Higher scores corresponded to more computer use. After each visit, patients rated the quality of the care received in the past six months. Researchers also analyzed communication using the Roter Interaction Analysis System by reviewing the video tapes. They took the computer use scores and divided them into three equal groups. They then conducted analyses, controlling for the length of visit, patient education level, general quality of life, type of clinician seen, years in practice, and specialty.

Patients who had clinical encounters with high computer use were less likely to their rate care as excellent compared to those who had encounters with low computer use (48% versus 83%). Clinicians in encounters with high computer use engaged in more negative rapport building. 

Bottom line here, high computer use by clinicians was associated with lower patient satisfaction, and differences in communication. This shouldn't be taken as an argument to remove computers and health information technology from patient care, because there certainly are benefits. But it should be a warning to all of us to consider how we can improve our communication with patients and make sure the computer use doesn't negatively impact our relationships with them. Richard Frankel, a colleague of mine and mentor, has some wise suggestions as to how we might do that in an accompanying editorial. He's an expert in this area and reading his piece is worth your time. Link's in the video description below.

Our second story is from Pediatrics. Children's food and beverage promotion on television to parents. Researchers analyzed a database of TV shows in the US for a year to look at the advertisements for children's packaged foods and beverages. Someone spent a lot of time watching kids' shows to build that database. They classified them as directed towards kids or their parents. About half the foods were directed at parents. Those ads usually promoted nutrition, health, and an active lifestyle. Kids' ads focused on taste. What's concerning is that the foods often advertised aren't really healthy. Check out some of these claims, all made about sugar-sweetened beverages: "with 1 combined serving of fruits and vegetables" (as if that's a lot), "40% fewer calories than most regular soda brands" (um, is that good?), "made with low-fat milk with calcium, vitamins A and D" (and that's the milk imprint at work), "no high-fructose corn syrup" (as if that constitutes the metric of healthy), " now with 35% less sugar" (which could still be a ton!), and my personal favorite "with just enough sugar for a wholesome everyday treat" (and how much is that??)

Pitching some of these foods as healthy is questionable. But clearly these companies know their audiences. Parents want to keep their kids healthy, kids want to eat what's tasty.

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