Challenge: Staying Patient-Centered While Taking Electronic Notes. Solution: Signposting

Kris English, PhD

Professor Emeritus

The University of Akron

An ongoing challenge in today’s health care system is managing computer use during patient encounters. Documenting each appointment is essential, but it can also disrupt our goal of providing patient-centered care (Ratanawongsa et al., 2016). In their literature review, Duke et al. (2013) noted that “the first minute of the consultation is often taken up with interacting with the computer rather than the patient” (p. 362), and that “patients worldwide express one major concern about computers in the office – the fixation of the physician’s eyes on the computer screen” (p. 359).

To manage the potential conflict between maintaining patient relationships and electronic records, let’s consider a relatively simple communication skill called signposting. The following definitions of signposting will resonate, since they are already routine practices in audiologic practice:

  • “A signpost is an explicit statement used to inform your patient what you are about to say or do. Signposts are often used to transition or change directions during a consultation. It makes clear to the patient what is going to happen” (Center for Health Care Communication, n.d.)
  • “Signposting progresses from one section to another using transitional statements; may include rationale for next section” (Silverman et al., p. 111)

Less routine might be the application of signposting while entering electronic notes:

  • “Signposting (telling the patient what you are doing as you transition to the computer) will signal that you are making a shift but still attending to his or her needs. Reading back what you have written, and then looking at your patient, also demonstrates active listening” (Duke et al., p. 362)

Applying a Familiar Skill to a New(ish) Situation

Even if not familiar with the term, audiologists “signpost” throughout an appointment: “Now that we’ve chatted about your concerns, let’s have you step into our testing booth …. That’s it for the testing portion. Let’s step into this area and talk about the results,” and so on. Like providing a roadmap, signposting reduces uncertainty and anxiety.

Applying the signposting skill to computer use includes these steps::

  1. “Introducing the computer” – “Our office uses an electronic medical record so I will occasionally need to type in information.” This process is no longer a novel experience to most patients, but mentioning it early provides the courtesy of a “heads up.”
  2. As needed, clearly signal any shifts from patient-focused to computer-focused moments by changes in posture, focus of visual attention, and a brief explanation such as, “I should summarize our chat so far in your record. This will take about a minute.”
  3. When done, either read what was typed to the patient (for transparency and accuracy checks) OR verbally indicate task completion as well shifting away from the screen, removing hands from the keyboard and mouse, and again facing the patient to re-establish eye contact and our undivided attention.

Importantly, signposting can involve both verbal and non-verbal cues.

Knowing the Name of a Skill Can Increase Its Use

Clinicians may not have known the name of a communication skill they already use, but to paraphrase Ursula LeGuin, “To know the name of a thing is to have power over it.” Signposting is a relatively straightforward patient-centered communication skill, but when it comes to computer use, applying it might require mindfulness as we break old habits and establish new ones. How will we teach ourselves the application of this important skill?  How will we monitor our efforts?


Center for Health Care Communication (n.d).  Signposting: An effective communication skill!

Duke P, Frankel R, & Reis S. (2013). How to integrate the electronic medical record and patient-centered communication into the medical visit: A skills-based approach. Teaching and Learning in Medicine, 25(4), 358-365.

Ratanawongsa N, Barton J, et al. (2016). Association between clinician computer use and communication with patients in safety-net clinics. JAMA Internal Medicine,176(1),125-128. doi:10.1001/jamainternmed.2015.6186

Silverman J., Kurtz S, & Draper J. (2013). Skills for communicating with patients (3rded.). Boca Ratan: CRC Press.