The ‘Magic Desk’ and Clinician-Patient Interactions

Two working at the magic desk.

Daniel M. Becker is the Director of the Center for Biomedical Ethics and Humanities, the Tussi and John Kluge Professor of Palliative Medicine, a Professor of Medicine in the Division of General Medicine, Geriatrics, and Palliative Care, and founding editor and current poetry editor of Hospital Drive.

In conjunction with a design team composed of faculty from General Medicine and Architecture, furniture designers and builders, and feedback from various patients, Becker conducted research on whether desk shape, computer position, and mobility influence clinician-patient interactions during clinic visits that now occur under the ever watchful eye of the electronic medical record (EMR). The goal of this design was to improve patient access to the computer screen while reducing clinician temptation to look at the EMR instead of the patient.

Following the installation of the “magic desk” patient and physician experiences in standard rooms and the redesigned room were compared. In addition, clinician focus groups provided feedback.

Becker found that the redesigned room facilitated eye contact and maintained high patient satisfaction (79 patients surveyed). Patients in the exam room with the magic desk felt that their doctors looked at them more than the computer, spent enough time with them, and were interested in their stories. All patients, regardless of room, reported being highly satisfied with their doctors and their care. In 75 percent of all of the sessions, clinicians preferred the redesigned room to the standard room. 80 percent of the time they found it was easier to make eye contact in the redesigned room, but it did not make it easier to listen or improve efficiency. The clinician focus group, found that the “Lazy Susan” aspect of the new desk prompted screen sharing with the patient and supported eye contact.

“I found it exciting and rewarding to look at our exam room through the eyes of designers.  Often when talking to patients I get to the point where all we can do is hope for the best while planning for the worst.  One often wants to “knock on wood” at that point in the conversation.  In the presence of the magic desk, I can knock on real wood, beautifully crafted wood, wood that reminds me and the patient that we are in this together,” said Becker.

This “Magic Desk project” uniquely shows the value of collaboration between medical professions, designers, and patients in redesigning medical facilities. In this case, Becker found that redesigning a simple, yet fundamental piece of furniture in the exam room can improve patient-doctor communication in the presence of an EMR. As medical records increasingly become digitized, maintaining patient satisfaction and communication through the use of innovative design strategies may become an integral part of our healthcare system.