Use of Pulmonary Artery Catheterization in US Patients With Heart Failure, 2001-2012

The good news is that there is growing interest in and scholarship on this topic.[6][7][8] Based on a review of the literature and my own research, I offer the mnemonic POISED (prepare, orient, information gathering, share, educate, debrief) as a memory aid for developing and reinforcing good computer use habits.Prepare | In busy primary care practices, the time-honored habit of reviewing the patient's medical record before entering the examination room may be overlooked and several precious minutes of face-to-face time may be spent silently reviewing the medical record with the patient in the examination room.This method is inefficient and can sometimes prove embarrassing when a patient reminds the physician of why he or she is there (eg, "You told me to schedule a follow-up for my diabetes care.").Preparation for the visit is key to efficiency and improved patient experience and trust.Orient | One best practice is to spend the first 1 to 2 minutes of the visit engaged in dialogue with the patient without using the computer at all.Once a welcoming atmosphere has been established, partnership statements such as, "I'm going to be using the computer from time to help me keep track of things" will alert the patient of your intent and rationale for using the computer.In a study of medical malpractice and communication, orientation statements proved to be protective while their absence was associated with a history of malpractice.9 Information Gathering | Recent scholarship suggests that some parts of the encounter should be centered on the physician and others should be centered on the patient or physician-patient relationship.10 Using the computer during informationgathering segments of the visit is both appropriate and expected by patients.Although this process may seem counterintuitive, if you do not enter information into the computer from time to time, you risk patients questioning how seriously you take their concerns.Timing is everything.Share | The computer is a wonderful source of information and patients appreciate it when they feel like they are partners in the care process.Turning the computer screen so patients can see what you are typing has the double benefit of partnership and serves as a way to check that what is being typed is what was said or meant.Educate | The computer screen is also useful as a teaching aid.With a click of the mouse, information such as a patient's weight, blood pressure, and blood glucose measurements can be shown as a histogram and become the basis for a conversation either reinforcing good health habits or talking about how to improve them.Debrief | Do not take for granted that instructions to patients are clear and perfectly understood.Examination room computers provide the perfect opportunity to use a "teach back" or a "talk back" format to assess the degree to which recommendations are understood.Being POISED for examination room computer use need not cost additional visit time.Used well, just the opposite is true.Medicine is fundamentally a human enterprise that is still practiced one conversation at a time.The study by Ratanawongsa et al 2 reminds us that our most vulnerable patients may be at even greater risk than others when a disproportionate amount of a physician's time is spent interacting with the computer screen and not with the patient.It is said that technology is neither good nor bad, but it is not neutral.Our challenge is to find the best ways to incorporate computers in the examination room without losing the heart and soul of medicine: the physician-patient relationship.