Electronic Theses and Dissertations

Identifier

367

Date

2011

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Communication

Committee Chair

Katherine Grace Hendrix

Committee Member

Amanda J. Young

Committee Member

Walter G. Kirkpatrick

Committee Member

Suzanne H. Lease

Abstract

The present study is a primarily qualitative case study examining the patient-clinician relationship. Clinicians practicing within an oncology practice with a reputation for patient-centered care responded to questions regarding how the introduction of an electronic medical record (EMR) and an exam room computer had affected their day-to-day clinical practice. Framed as a wicked problem (a problem that could not be solved using a linear methodology), I believed clues to understanding a method for incorporating use of an exam room computer into a clinical visit while maintaining empathic communication with the patient could be found by exploring the experience of clinicians who had faced the dilemma. Only three of the nine clinicians interviewed reported routinely using the computer to document the visit while the patient was in the room. The exam room computer was perceived by the clinicians as a third interaction in addition to the patient-clinician relationship and had changed the dynamics of the clinical visit. Identified disadvantages to using an exam room computer included physical environmental factors and relational problems created by system failures or slowness where the clinician felt obligated to explain the unwelcome interruptions of the clinical visit by acknowledging to the patient the interference of the "damn computer." Environmental factors interfered with empathic communication by limiting nonverbal communication, particularly eye contact. Similarly, relational factors made empathic communication more difficult by interrupting the flow of conversation or pulling the clinician's attention away from the patient. The clinicians who used the exam room computer in the presence of the patient were unable to verbalize a specific technique they had discovered to unable them to maintain an empathic connection with their patients. However, in explaining how they had adapted their practice after the introduction of the exam room computer they demonstrated a strong commitment to their patients through mindfulness and reflexivity. The empathic connection between these clinicians and their patients was maintained through an awareness of how their words and behavior might be perceived by the patient, and a conscious effort to keep the patient at the center of the interaction despite distractions introduced by the computer.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to the local University of Memphis Electronic Theses & dissertation (ETD) Repository.

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