If reading, writing, or using a computer, you must ensure this does not interfere with dialogue or rapport

One of the most important non-verbal skills is appropriate eye contact

• This is broken when you refer to the patient’s written or computer record
• Breaking of eye contact while the patient is speaking causes patients to … until eye contact is regained:
  • Withhold their until reply
  • Pause in mid-utterance
  • Use body language to catch their doctor’s gaze
  • Decrease their fluency of speech
• Doctors also often miss or forget information given to them by the patient while they are reading notes
• All in all, this decreases efficiency, and increases consultation time

Eye contact demonstrates that you are ready to engage, participate, and listen

• Deliberately postpone looking to patient records until your patient completes their initial statement (or read it before you enter the room)
• Wait for opportune moments to look at your notes / take notes
• Signposting: clearly separate listening from note reading by verbalizing these with the patient

On use of computers and electronic medical records (EMRs)

• Divide the patient encounter into patient- and computer-focused portions that are clearly demarcated for the patient via signposting
• Signposting can be done either verbally or non-verbally (changes in body language and focus of gaze)
• Engage your patient: share the screen with them, read out loud when typing

Exercise: Maintaining communication and rapport while charting in an EMR is a difficult skill to learn. Role play and practice interviewing a patient while taking notes using a computer.

Silverman, J., Kurtz, S., & Draper, J. (2013). Skills for Communicating with Patients (Thrid Edit). London: Radcliffe Publishing.