‘Screen-time transferential interference’ in encounters with patients
This sentiment is echoed in Winnicott’s concept of the “good-enough” mother (or parent), formulated years earlier, in which failures in infant−caretaker attunement are inevitable and to be expected—as long as repair outcompetes deficiency.5
Divided attention: Patient or screen? Or both?
What we can understand by applying the ideas of transference and optimal attunement to the clinical encounter is how important uninterrupted face-to-face time with the patient is. Indeed, nonverbal communication from the patient, expressed though body language and facial articulation, is particularly salient to the practice of psychiatry. Information technology— especially the electronic health record—now encroaches on the time-honored central dyad of the patient-physician interaction by introducing a third entity into the traditional encounter.
Clinical misattunement, as understood through the still-face paradigm, increases in proportion to a provider’s need to divide his (her) attention between the patient and the computer screen. And, as the degree of misattunement increases, positive transference is more difficult to establish and maintain. The quality of the clinical encounter then deteriorates, undermining the care of the patient and reducing physician satisfaction.
Acknowledgment
Philip LeFevre, MD, Department of Neurology & Psychiatry, Saint Louis University, St. Louis, Missouri, provided inspiration and encouragement in the development of the manuscript.
Disclosure
Dr. Afanasevich reports no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
