Computers in the new consultation: within the first minute

Background. Computers are now commonplace in the general practice consultation in many countries and literature is beginning to appear that describes the effects of this presence on the doctor-patient relationship. Concepts such as patient centredness emphasize the importance of this relationship to patient outcomes, yet the presence of the computer has introduced another partner to that relationship. Objective. To describe the patient-doctor-computer relationship during the opening period of the consultation. Methods. Twenty GPs provided 141 consultations for direct observation, using digital video. Consultations were analysed according to Goffman's dramaturgical methodology. Results. Openings could be described as doctor, patient or computer openings, according to the source of initial influence on the consultation. Specific behaviours can be described within those three categories. Conclusions. The presence of the computer has changed the beginning of the consultation. Where once only two actors needed to perform their roles, now three interact in differing ways. Information comes from many sources, and behaviour responds accordingly. Future studies of the consultation need to take into account the impact of the computer in shaping how the consultation flows and the information needs of all participants.