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Qualitative Health Research
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Electronic Medical Records in Diabetes Consultations: Participants' Gaze as an Interactional Resource

Penny Rhodes

Institute for Health Research, Bradford, West Yorkshire, United Kingdom, penny.rhodes{at}bradfordhospitals.nhs.uk

Neil Small

University of Bradford, Bradford, West Yorkshire, United Kingdom

Emma Rowley

University of Nottingham, Nottingham, Nottinghamshire, United Kingdom

Mark Langdon

Department of Work and Pensions, Sheffield, United Kingdom

Steven Ariss

University of Bradford, Bradford, West Yorkshire, United Kingdom

John Wright

Institute for Health Research, Bradford, West Yorkshire, United Kingdom

Two routine consultations in primary care diabetes clinics are compared using extracts from video recordings of interactions between nurses and patients. The consultations were chosen to present different styles of interaction, in which the nurse's gaze was either primarily toward the computer screen or directed more toward the patient. Using conversation analysis, the ways in which nurses shift both gaze and body orientation between the computer screen and patient to influence the style, pace, content, and structure of the consultation were investigated. By examining the effects of different levels of engagement between the electronic medical record and the embodied patient in the consultation room, we argue for the need to consider the contingent nature of the interface of technology and the person in the consultation. Policy initiatives designed to deliver what is considered best-evidenced practice are modified in the micro context of the interactions of the consultation.

Key Words: checklists • chronic illness • communication, nurse—patient • computer • conversation analysis • diabetes • empowerment • medical/health care discourse • microanalysis of behavior • technology • visual methods • electronic medical record

Qualitative Health Research, Vol. 18, No. 9, 1247-1263 (2008)
DOI: 10.1177/1049732308321743
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