From talk to text: Extending the arc of doctor patient communication research to real-time visit documentation

The scientific study of doctor-patient communication got its start with a textbook published almost nine decades ago. Based on 16 years of conversations between psychiatry residents and patients, it featured audio recordings as a method for studying the subtleties of verbal interaction in the clinical context. Hundreds of studies based on audio and video technology have been published since. The purpose of this paper is threefold. First, I provide a brief history of a line of inquiry based on direct observation and coding of recorded encounters. Second, I describe the development of the Four Habits of Highly Effective Clinicians, one of several evidence-based frameworks for studying and teaching about the medical interview. Third, I describe the phenomenon of documenting in the electronic health record (EHR) while simultaneously providing care. Documenting while doctoring (DWD) is both a resource and a constraint on clinicians' time and attention. Notwithstanding, its effects on processes and outcomes of care have not typically been accounted for in doctor patient communication frameworks. To that end I describe a mnemonic POISED, to facilitate EHR use in the exam room.

In 2004 only 1 of 10 US physicians' offices used an EHR; in 2023, it was 9 out of 10. Pressures to increase efficiency and billing have resulted in a migration of the EHR from the back room into the exam room. A gap currently exists in research on the effects of DWD on doctor patient communication and outcomes of care. Accumulating evidence suggests that DWD has resulted in increased distraction, inaccurate data recording, and in some cases poorer outcomes of care.

Larger studies across multiple medical specialties and a range of patient populations will be necessary to better understand the costs and benefits of the intersection of talk, text, and technology in doctor-patient communication and relationships.