Talking with the alien: interaction with computers in the GP consultation.

This study examines New Zealand GPs' interaction with computers in routine consultations. Twenty-eight video-recorded consultations from 10 GPs were analysed in micro-detail to explore: (i) how doctors divide their time and attention between computer and patient; (ii) the different roles ascribed to the computer; and (iii) how computer use influences the interactional flow of the consultation. All GPs engaged with the computer in some way for at least 20% of each consultation, and on average spent 12% of time totally focussed on the computer. Patterns of use varied; most GPs inputted all or most notes during the consultation, but a few set aside dedicated time afterwards. The computer acted as an additional participant enacting roles like information repository and legitimiser of decisions. Computer use also altered some of the normal 'rules of engagement' between doctor and patient. Long silences and turning away interrupted the smooth flow of conversation, but various 'multitasking' strategies allowed GPs to remain engaged with patients during episodes of computer use (e.g. signposting, online commentary, verbalising while typing, social chat). Conclusions were that use of computers has many benefits but also significantly influences the fine detail of the GP consultation. Doctors must consciously develop strategies to manage this impact.