The desk-top computer as a magic box: patterns of behaviour connected with the desk-top computer; GPs' and patients' perceptions

BACKGROUND: The use of computers in general practice is becoming increasingly common. There has been concern about effects on doctor-patient communication. OBJECTIVES: The aim of this study was to identify common patterns in the use of desk-top computers by GPs with regard to interaction with the patients, and to assess the GPs' and patients' perceptions of the use of the computer. METHOD: Thirty-nine video-taped consultations with five different GPs were analysed inductively, inspired by the principles of 'grounded theory'. On separate occasions the five GPs and 12 of the previously video-taped patients watched and commented on the video recordings of their own consultation. RESULTS: The study showed that the computer was sometimes used in a way that was not originally intended. Use of the computer could be identified as a way of obtaining 'time-out' in the consultation. It could also be a referral to a 'magic box'. The conversation often changed when the computer was used. The interviews showed that the patients lacked understanding about the computer's functions. They also lacked knowledge about the possibility of loss of confidentiality with electronic files. The patients found it disturbing not knowing what their doctor was doing when he worked on the computer, and they preferred being able to see the computer screen. The GPs were surprised at how their own use of the computer looked on the video, and as a result of the interview they wanted to change their behaviour. CONCLUSIONS: It is concluded that patients need more information about the use of computers by GPs, and that GPs may benefit from paying more attention to their computer use.