Do general practitioners change how they use the computer during consultations with a significant psychological component?

Objectives: To describe the patterns of computer use during patient visits to family doctors and to determine whether doctors alter their pattern of computer use in consultations which have significant psychological content.

Design: Observational, non-randomised cluster trial with data being collected from videotaped consultations.

Setting: Three inner-city Family Practice offices involved in physician training in Belfast, Northern Ireland.

Participants: Ten family doctors, who declared using computers during their consultations and consecutive consenting adult patients attending these doctors.

Results: One hundred consultations were videotaped (59% patient participation rate). The average consultation time was 9min 48s, and number of problems per consultation was 1.9. Three broad styles of computer use were defined: (1) "end users" who only used the computer at the end of a consultation to summarise the consultation, (2) "continuous users", who interacted with the computer throughout the consultation, and (3) "minimal users", who only ever used the computer at the end of the consultation mostly to issue prescriptions. Of the 100 consultations videoed 37% were of a psychological nature. Consultations with psychological content were on average longer (11min 47s vs. 8min 39s) and the average percentage time doctors spent on the computer was about half that of non-psychological consultations (11% vs. 23% and p<0.001).

Conclusion: The doctors were found to adopt one of three broad styles of computer use during their consultations. In consultations with observable significant psychological content doctors significantly reduce the proportion of time at the computer suggesting an ability to appropriately tailor their use of the computer during consultations.