Competing lines of action: A sociolinguistic approach to the human-computer interface in doctors' consultations

[摘要] As computers continue to infiltrate medical practice, it is important to understand the impact of technology on the medical interview. In this dissertation, I examined the effect of computer use on doctor-patient conversation to understand how physicians manage competition over their attention by the computer and the patient. By video recording patient-physician interactions, I was able to describe how the computer, like the physician or patient, participates actively in the medical interview. The computer shapes the interview design, as its onscreen prompts dictate forthcoming courses of action. Thus the needs of the electronic patient listed onscreen and those of patient in-person overlap and at times even clash. The responsibility to coordinate this three-way interaction mostly falls on the physician, who has to manage expectations from both the patient and the computer. The situation is also difficult for patients because while they are participants and invited players in the conversation, they do not have access to computer’s turns. Physicians managed this competition through gaze, verbal resources such as 'onscreen commentary,' physical orientation, or a combination of all of these strategies. Physicians turned their head between computer and patient while sustaining involvement with the other. They kept their lower bodies in line with the computer to communicate engagement with it, and used their head, torso, and gaze to engage with the patient simultaneously but temporarily. The practice of narrating what the physician sees on the computer monitor – what I call onscreen commentary – may help physicians draw imaginary 'fences' to protect their interaction with the computer and emphasize the patient’s by-stander or 'on hold’ status. Onscreen commentary also affords patients’ access into what physicians are doing on the computer. The arrangements around the computer which are negotiated between patients and doctors lead to various generic organizations that result in various participation frameworks. I have described the challenges associated with interviewing the patient while using the computer. Insights from this research can be used to support the meaningful use of health information technology and provide a framework for improving the use of computers in the medical interview.

[发布机构] the University of Pittsburgh