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Br J Gen Pract. 2010 April 1; 60(573): 293.
PMCID: PMC2845492

Looking at the patient

I wish to comment on the editorial in the February 2010 issue of the Journal.1 My personal experience of analysing my consultations by video made it clear to me that the computer served as a very real barrier to effective non-verbal communication with patients. I noted that the position of the computer on my desk was of considerable importance. As the authors describe, the position of the lower body identified by Ruusuvuori2 is crucial and as such, I found that angling the computer keyboard and monitor toward the patient without blocking my direct view, seemed to integrate the computer into the interaction with the patient much more effectively. This is a very simple reorganisation but interestingly I noted that in all of the eleven consulting rooms in our building, we were operating with a keyboard and screen placed at angle of 45–90 degrees away from the patient.

I agree entirely with the need to give full attention to the patient's opening statements before using the computer and also in signposting any referral to the screen. However, I have also been increasingly aware of the challenge of recording a full computerised record within the time constraints of a 10-minute consultation. I have been experimenting with entering data on the computer without breaking eye contact with the patient. This requires typing skills, however, I have managed to pick these up having previously used the ubiquitous two-to-four finger typing technique over a relatively short period of 6 months or so and now consider it to have been a useful investment of time. This technique needs structuring with some explanation to the patient and seems to be best carried out during free flowing conversation in the consultation. However, it allows data to be entered unobtrusively and contemporaneously while still being able to engage in the offer and receipt of non-verbal information.

REFERENCES

1. Silverman J, Kinnersley P. Doctors' non-verbal behaviour in consultations: look at the patient before you look at the computer. Br J Gen Pract. 2010;60:76–78. [PMC free article] [PubMed]
2. Ruusuvuori J. Looking means listening: coordinating displays of engagement in doctor–patient interaction. Soc Sci Med. 2001;52:1093–1108. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners