Computer setup - Example 4

This image has been provided by Dr. Karim Keshavjee and demonstrates the computer configuration in an exam room from the COMPETE study that was carried out in Hamilton, Ontario. In the image, a keyboard is mounted on a sliding tray under a traditional desk. The monitor (CRT) is mounted on a flexible arm off the corner of the desk to be minimally intrusive and is positioned so that the physician and patient can view the screen at the same time. As you can see, the physician is entering data using a touchpad and pen. If you would like to comment on this layout or have suggestions on how you have used a similar layout, please click on the 'Comments' link below.

Comments

[Karim]

Although this is how we set up this particular clinic in the COMPETE project, it is not the recommended approach.

There are two preferred approaches:

1. View screen with the patient. To do this effectively, the patient and physician need to be sitting side-by-side. I have seen this effectively done where the desk holding the monitor is against the wall. The physician and the patient sit facing each other in front of the desk. When the physician enters information, she swivels her chair to do so. The patient can easily turn their head to see what is being entered.

I have not seen too many physicians do this effectively. However, when it works, it works really well, as patients can sometimes tell you of errors in their medical chart.

2. View screen privately. In this scenario, the patient sits beside the desk on which the monitor resides. The monitor is placed in such a way that the physician can see the monitor and the patient WITHOUT any head movement. All the physician does is move their eyes to provide eye contact to the patient or to see where they should place the cursor.

I cannot over-emphasize the importance of keyboarding skills in either context. It is difficult to make patients feel like you really care when you are hunched over the keyboard hunting and pecking. It is also difficult to make patients feel that you empathize with them if you can't give eye contact on a regular basis throughout the encounter. Good placement of the monitor and good keyboarding skills make the difference.