PhDElectronic Patient Records (EPRs) are in widespread use in UK general\ud
practice. Although often taken-for-granted by clinicians, managers,\ud
administrators and patients, there is limited understanding of how EPRs shape\ud
care processes and healthcare interactions in this setting. The EPR is\ud
ubiquitous in practice, but its social impact remains under-researched.\ud
In this thesis I present a novel approach to examining the role of the EPR,\ud
which draws on ethnography and discourse analysis. My work is based on eight\ud
months of ethnographic observation in clinical and administrative areas of two\ud
general practices. This included observation of clinical consultations, with videorecording\ud
of the interpersonal interaction and contemporaneous screen capture\ud
of the EPR. This opens up the â\u80\u98EPR-in-useâ\u80\u99 to detailed scrutiny. In my analysis,\ud
which draws particularly on the theoretical work of Goffman and Bakhtin, I pay\ud
close attention to the detail of local action and interaction, whilst maintaining\ud
sensitivity to the wider context of the general practice organisation. This makes\ud
an original contribution to the emerging field of linguistic ethnography.\ud
My analysis shows that the EPR contributes to shaping and regimenting\ud
interactions and care practices in profound ways, both within the consultation\ud
and more widely in general practice organisations. It creates new opportunities,\ud
but also creates new demands and tensions. In particular, it sharpens the\ud
tension between different ways of framing the patient â\u80\u93 the patient as â\u80\u98individualâ\u80\u99\ud
and the patient as â\u80\u98one of a populationâ\u80\u99 â\u80\u93 the latter a more institutional version\ud
of the patient. This creates what I have called a â\u80\u98dilemma of attentionâ\u80\u99 for\ud
clinicians engaged in patient care. I show ways in which the EPR contributes to\ud
the bureaucratisation of care, the construction and circulation of authority within\ud
and beyond the consultation, and the production of new notions of patienthood\ud
and professional habitus in contemporary general practice