Rouf E et al. 2007 "Computers in the exam room: differences in physician-patient interaction may be due to physician experience."

"BACKGROUND: The use of electronic medical records can improve the technical quality of care, but requires a computer in the exam room. This could adversely affect interpersonal aspects of care, particularly when physicians are inexperienced users of exam room computers.
OBJECTIVE: To determine whether physician experience modifies the impact of exam room computers on the physician-patient interaction.
DESIGN: Cross-sectional surveys of patients and physicians.
SETTING AND PARTICIPANTS: One hundred fifty five adults seen for scheduled visits by 11 faculty internists and 12 internal medicine residents in a VA primary care clinic.
MEASUREMENTS: Physician and patient assessment of the effect of the computer on the clinical encounter.
MAIN RESULTS: Patients seeing residents, compared to those seeing faculty, were more likely to agree that the computer adversely affected the amount of time the physician spent talking to (34% vs. 15%. P=0.01). looking at (45% vs. 24%, P=0.02). and examining them (32% vs 13%. P=0.009). Moreover, they were more likely to agree that the computer made the visit feel less personal (20% vs. 5%. P=0.017). Few patients thought the computer interfered with their relationship with their physicians (8% vs. 8%). Residents were more likely than faculty to report these same adverse effects, but these differences were smaller and not statistically significant.
CONCLUSION: Patients seen by residents more often agreed that exam room computers decreased the amount of interpersonal contact. More research is needed to elucidate key tasks and behaviors that facilitate doctor-patient communication in such a setting."