If you have a chronic illness, chances are that you see more than one physician. Some of them may use a computer when seeing you while others may not. What do you think of doctors who use computers versus those who do not? This may not seem a big issue, but it apparently can be. In a nice study, Hal Arkes and colleagues looked at whether a physician who used a computer-assisted diagnostic system would be rated less capable than a physician who did not. They conducted four experiments. Students played the role of a patient with a possible ankle fracture (experiment 1) or a possible deep vein thrombosis (experiment 2). They read a scenario that described an interaction with a physician who used no computer, one who used an unspecified computer system, or one who used a system developed at a prestigious medical center. Participants were then asked to rate the interaction on five criteria, the most important of which was the diagnostic ability of the physician. In experiment 3, patients in the waiting room of a clinic were randomly assigned to the same three types of groups as used in experiment 1. In experiment 4, 3rd- and 4th-year medical students read a scenario of a physician-patient interaction and were randomly assigned to 1 of 4 groups: the physician used no computer, heeded the recommendation of a computer system, defied a recommendation of a system by treating in a less aggressive manner, or defied a recommendation of a diagnostic by treating in a more aggressive manner. Results showed that participants always deemed that the physician who used no decision aid had the highest diagnostic ability.

COMMENTS: Patients may believe that a physician who uses a diagnostic system is not as capable as a physician who makes the diagnosis with no assistance from such a program. Like most of you, we have seen doctors who either do or do not use computer systems when treating us. We do feel somewhat uncomfortable to those who spend more time in looking at a computer screen than interviewing us. It may seem impersonal. On the other hand, we like to see our doctors spend some time at the computer when we see them. This way, we know they are checking on information they have about us. It is particularly nice when physicians check the computer when they are prescribing a new drug. This way, they not only see if we need another drug, but if it would interact in a bad way with the other medicines we take. You feel more comfortable when the new drug is prescribed. What do you think?

H.R. Arkes et al. Patients derogate physicians who use a computer-assisted diagnostic aid.Medical Decision Making, 2007;27:189-202.