Purpose: The dynamics of the patient-physician encounter in the outpatient clinical setting has changed with the advent of electronic medical health records. Previous studies suggest that computer use does not diminish patient satisfaction as long as the physician maintains appropriate verbal and nonverbal communication (posture, tone of voice, gesture, and direct eye contact). We performed a case-control study to analyze the role of computer positioning and its effect on direct eye contact.
Method: A prospective, comparative study of 54 patient encounters assessing the effects of computer position setup on the amount of direct eye contact was performed. The setups aligned clinician, computer monitor and keyboard: (1) on axis, (2) off axis, and (3) a hybrid setup where a wireless keyboard was placed on-axis and the monitor was off-axis. The encounters were video-recorded. The time spent by the provider in direct patient eye contact, computer time, examination time were recorded. The number of <5 second glances per encounter were also recorded. Data was collected and analyzed using one-way ANOVA and chi-square test of independence.
Result: Chi-square test for independence revealed no significant correlation between computer setup and time of patient eye contact time between the groups (p=0.999). One-way ANOVA revealed a significant difference in the number of <5 second glances between the groups, with the on-axis and hybrid setups yielding higher number of short glances. (p=0.005)
Conclusion: Computer position can play a role in increasing patient physician eye contact. These findings may be relevant when designing clinical encounter space.