| dc.description.abstract | Electronic Patient Records (EPRs) are in widespread use in UK general
practice. Although often taken-for-granted by clinicians, managers,
administrators and patients, there is limited understanding of how EPRs shape
care processes and healthcare interactions in this setting. The EPR is
ubiquitous in practice, but its social impact remains under-researched.
In this thesis I present a novel approach to examining the role of the EPR,
which draws on ethnography and discourse analysis. My work is based on eight
months of ethnographic observation in clinical and administrative areas of two
general practices. This included observation of clinical consultations, with videorecording
of the interpersonal interaction and contemporaneous screen capture
of the EPR. This opens up the ‘EPR-in-use’ to detailed scrutiny. In my analysis,
which draws particularly on the theoretical work of Goffman and Bakhtin, I pay
close attention to the detail of local action and interaction, whilst maintaining
sensitivity to the wider context of the general practice organisation. This makes
an original contribution to the emerging field of linguistic ethnography.
My analysis shows that the EPR contributes to shaping and regimenting
interactions and care practices in profound ways, both within the consultation
and more widely in general practice organisations. It creates new opportunities,
but also creates new demands and tensions. In particular, it sharpens the
tension between different ways of framing the patient – the patient as ‘individual’
and the patient as ‘one of a population’ – the latter a more institutional version
of the patient. This creates what I have called a ‘dilemma of attention’ for
clinicians engaged in patient care. I show ways in which the EPR contributes to
the bureaucratisation of care, the construction and circulation of authority within
and beyond the consultation, and the production of new notions of patienthood
and professional habitus in contemporary general practice. | en_US |
