As physicians begin to use computer technology in front of patients during clinical encounters, concern has been raised that such computer use may exert a dehumanizing effect on the physician-patient relationship. To investigate this concern, we measured patient reactions to physician use of a computerized medical record system during clinical encounters.Adult patients who presented for clinical care were randomized into three groups. With the first group, the physician used a standard paper-and-pencil charting system during the encounter. With the second group, the physician used a computerized medical record system with keyboard input. With the third group, the physician used the computerized medical record system with voice input. Patient reactions were measured with a questionnaire that the patients completed after the clinical encounter.For most components of the physician-patient relationship studied in this report, questionnaire scores did not differ significantly among the three study groups. Patients in the voice input group rated physician explanations of patient problems significantly higher than patients in the other two groups. There was a trend for patient confidence in the physician to be higher in the keyboard input group. Although measured encounter durations were significantly shorter in the computer groups, there were no differences in patient satisfaction with encounter duration among the three groups.Physician use of computers during clinical encounters was not associated with a decline in the perceived quality of the physician-patient relationship.