The electronic patient record: a linguistic ethnographic study in general practice

PhDElectronic 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

Are problem-oriented medial records (POMR) suitable for use in GPs' daily practice?

Problem-oriented functions have been implemented in almost all Belgian GPs' software systems since 2003. We therefore investigated whether some of them - especially the explicit linking procedure between treatments or referrals and the relevant problems - can be used by GPs in their current daily practice.In 2005, within the Belgian ResoPrim project, we organized data collection, mainly around the theme of "hypertension and cardiovascular risk factors", by 26 volunteer GPs' practices using three different software systems. Data were collected prospectively over six weeks in early 2005, and retrospectively for 2004. In this paper we report only on the part of the study that aimed to assess the linking procedure. For all patients and hypertensive patients alike, the key indicators used were the percentage of (problem-) linked drugs among the drugs extracted, the percentage of anti-hypertensive (problem-) linked drugs among anti-hypertensive drugs extracted, and the percentage of (problem-) linked referrals among the number of referrals extracted.For all patients, the data collected relate to 10,914 contacts (7,831 patients) in 2005, and to 74,878 contacts (16,813 patients) in 2004. Large variations were observed per software system and GP, and also over time. The percentage of linked drugs rose from 2% (2004, two GPs) to 36% (2005, fourteen GPs). For linked referrals the percentage was 65% in 2004 vs. 75% in 2005. Our study shows that some functions related to the problem-oriented patient record were spontaneously used by GPs in daily practice. This use increased during collaboration with the primary care research network. This increase was not restricted to the theme of data collection (i.e. not restricted to hypertensive patients, to anti-hypertensive drugs or to links with cardiovascular problems)

The Discourse of 'Distortion' and Health and Medical News Reports: A Genre Analysis Perspective

The advent of medical journalism was initially felt to be an answer to the problem of communicating health and medical information to the public. However, currently, there is a concern among scientists with the way the media, newspapers in particular, communicate health and medical information. The concern of the medical community in particular and of the scientific community in general is that newspapers ‘distort’ health and medical information. In order to deal with this ‘perceived’ problem, scientists adopt a mechanical view and propose to solve it by issuing guidelines for journalists to follow when writing health and medical news. Close investigation of journalistic practice shows that many of the proposed guidelines are already present in journalistic practice, and yet, the concern for ‘distortion’ remains. The overall aim of the thesis is to contribute to this issue. Adopting an Applied Linguistics perspective, more specifically, using the discourse analytic methodology of Genre Analysis, the thesis demonstrates that Health and Medical News Reports are first and foremost news stories and that the proposed guidelines fail to achieve the envisaged changes precisely because they seem to be ignorant of this essential reality. In order to reach this conclusion, Genre Analysis is applied to different types of texts with a view to comparing their structures. Some of the text types used have already been described in the literature, but others are analysed for the first time in this thesis. Thus, comparison is made between Health and Medical Research Articles and Health and Medical News Reports, between Popularised Health and Medical Texts and Health and Medical News Reports, between News Texts and Health and Medical News Reports and between Health and Medical Press Releases and Health and Medical News Reports. Genre Analysis shows that Health and Medical News Reports are first and foremost news stories and, therefore, that the discourse of ‘distortion’ is somewhat ‘misguided’. However, because of its nature as a structural analysis, Genre Analysis leaves one important question unanswered, namely the ‘why’ of the discourse of distortion. Although it is beyond the scope of this thesis to investigate this question, in the thesis, it is indicated that a more context-sensitive analysis, using Critical Discourse Analysis (CDA) for example, could fruitfully be pursued. This thesis draws on four types of data. The main data set consists of Health and Medical News Reports published in The Herald and The Guardian between April and May 2007, where possible, corresponding press releases were collected. Email interviews were conducted with authors whose research was reported in the two newspapers. Finally, ethnographic observation of newsrooms and face-to-face semi-structured interviews were conducted with journalists who wrote the reports over a period of one week

Discourse of 'distortion' and health and medical news reports: a genre analysis perspective

The advent of medical journalism was initially felt to be an answer to the problem of communicating health and medical information to the public. However, currently, there is a concern among scientists with the way the media, newspapers in particular, communicate health and medical information. The concern of the medical community in particular and of the scientific community in general is that newspapers ‘distort’ health and medical information. In order to deal with this ‘perceived’ problem, scientists adopt a mechanical view and propose to solve it by issuing guidelines for journalists to follow when writing health and medical news. Close investigation of journalistic practice shows that many of the proposed guidelines are already present in journalistic practice, and yet, the concern for ‘distortion’ remains. The overall aim of the thesis is to contribute to this issue. Adopting an Applied Linguistics perspective, more specifically, using the discourse analytic methodology of Genre Analysis, the thesis demonstrates that Health and Medical News Reports are first and foremost news stories and that the proposed guidelines fail to achieve the envisaged changes precisely because they seem to be ignorant of this essential reality. In order to reach this conclusion, Genre Analysis is applied to different types of texts with a view to comparing their structures. Some of the text types used have already been described in the literature, but others are analysed for the first time in this thesis. Thus, comparison is made between Health and Medical Research Articles and Health and Medical News Reports, between Popularised Health and Medical Texts and Health and Medical News Reports, between News Texts and Health and Medical News Reports and between Health and Medical Press Releases and Health and Medical News Reports. Genre Analysis shows that Health and Medical News Reports are first and foremost news stories and, therefore, that the discourse of ‘distortion’ is somewhat ‘misguided’. However, because of its nature as a structural analysis, Genre Analysis leaves one important question unanswered, namely the ‘why’ of the discourse of distortion. Although it is beyond the scope of this thesis to investigate this question, in the thesis, it is indicated that a more context-sensitive analysis, using Critical Discourse Analysis (CDA) for example, could fruitfully be pursued. This thesis draws on four types of data. The main data set consists of Health and Medical News Reports published in The Herald and The Guardian between April and May 2007, where possible, corresponding press releases were collected. Email interviews were conducted with authors whose research was reported in the two newspapers. Finally, ethnographic observation of newsrooms and face-to-face semi-structured interviews were conducted with journalists who wrote the reports over a period of one week