Abstract: Losing Ctrl of Relationships: The Impact of Technology use on Provider Credibility, Nonverbal Immediacy, and Patient Satisfaction

◆ Braidyn Lazenby, The University of Alabama

Rationale: The use of technology during patient-provider interactions has increased in an effort to make healthcare more efficient. While technologies such as electronic health records allow patients to have easier access to their own healthcare, healthcare providers have recently received criticism for their perceived lack of time and attention to their patients. The purpose of this study was to analyze how technology use in a medical interaction affects aspects such as communication behaviors, patient satisfaction, perceived quality of care, credibility, and provider immediacy.

Method: This study uses a quasi-experimental survey design. The author wrote a script and two actors performed the scene, once with the provider using technology and once with the provider using traditional pen and paper. Participants (N = 227) were shown a video of a patient-provider interaction with either a provider using pen and paper or a laptop during a patient exam and then asked to rate provider communication behavior and provider accommodation, credibility, nonverbal immediacy, and quality of care and patient satisfaction. The majority of participants were female (n = 169) and Caucasian (n = 195).

Results: Mean differences suggested that participants who saw the provider using pen and paper rather than a laptop scored the provider higher in all categories. The results of the t-tests suggest that there were significant differences in nonverbal immediacy between providers who use pen and paper and providers who use a laptop (t(225)=3.90; p<.01). Specifically, nonverbal immediacy behaviors related to eye-contact were significant: looking at the patient (t(225)=6.23; p<.01) and the extent to which a physician looked elsewhere (t(225)=4.32; p<.01). Physician accommodation was also significant (t(225)=2.64; p<0.1), while expected communication behavior approached significance (t(225)=1.83; p=.07). There were no significant differences between groups in credibility, (t(225)=1.23; p=.22), including expertise (t(225)=1.27; p=.205), trustworthiness (t(225)=1.09; p=.28), and goodwill (t(225)=1.23; p=.22). There were no significant differences between groups for quality of care (t(225)=1.40; p=.16) or patient satisfaction (t(225)=1.87; p=.06).

Implications: Although nonverbal immediacy and provider accommodation were the only significant variables, mean differences suggested that providers who use pen and paper are rated higher across the board. These results suggest that patients are especially attuned to providers who show accommodating behaviors such as listening skills and politeness, and present immediate behaviors that are associated with physical nonverbals, such as smiling and eye-contact. The results suggest that the patient-provider relationship is more than just a passive relationship. Patients want to feel understood, respected, and listened to by a provider who is kind and caring. While previous research has had a difficult time deciding what the role of a provider should be in a patient’s life (Conlee et al., 1993; Sobczak et al., 2017), this study suggests that patients want a trustworthy relationship with providers who embody accommodating behaviors. Technology use in the patient-provider relationship is still uneven, leaving room for providers to learn to use multiple forms of technology in order to be comfortable using accommodating and immediate behaviors with patients while effectively using laptops, EHRs, and other technologies during patient appointments.