 Displays of authority in the clinical consultation: A linguistic ethnographic study of the electronic patient recordDeborah Swinglehurst Social Science & Medicine, 2014, vol. 118, issue C, 17-26 Abstract: The introduction of computers into general practice settings has profoundly changed the dynamics of the clinical consultation. Previous research exploring the impact of the computer (in what has been termed the ‘triadic’ consultation) has shown that computer use and communication between doctor and patient are intricately coordinated and inseparable. Swinglehurst et al. have recently been critical of the ongoing tendency within health communication research to focus on ‘the computer’ as a relatively simple ‘black box’, or as a material presence in the consultation. By re-focussing on the electronic patient record (EPR) and conceptualising this as a complex collection of silent but consequential voices, they have opened up new and more nuanced possibilities for analysis. This orientation makes visible a tension between the immediate contingencies of the interaction as it unfolds moment-by-moment and the more standardised, institutional demands which are embedded in the EPR (‘dilemma of attention’). In this paper I extend this work, presenting an in-depth examination of how participants in the consultation manage this tension. I used linguistic ethnographic methods to study 54 video recorded consultations from a dataset collected between 2007 and 2008 in two UK general practices, combining microanalysis of the consultation with ethnographic attention to the wider organisational and institutional context. My analysis draws on the theoretical work of Erving Goffman and Mikhail Bakhtin, incorporating attention to the ‘here and now’ of the interaction as well as an appreciation of the ‘distributed’ nature of the EPR, its role in hosting and circulating new voices, and in mediating participants' talk and social practices. It reveals – in apparently fleeting moments of negotiation and contestation – the extent to which the EPR shapes the dynamic construction, display and circulation of authority in the contemporary consultation. Keywords: UK; Electronic patient record; Linguistic ethnography; Authority; Health communication; Primary health care (search for similar items in EconPapers) Downloads: (external link) Related works: Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text Persistent link: https://EconPapers.repec.org/RePEc:eee:socmed:v:118:y:2014:i:c:p:17-26 Ordering information: This journal article can be ordered from DOI: 10.1016/j.socscimed.2014.07.045 Access Statistics for this article Social Science & Medicine is currently edited by Ichiro (I.) Kawachi and S.V. (S.V.) Subramanian More articles in Social Science & Medicine from Elsevier |
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