ABSTRACT
Electronic patient records (EPRs) are taken for granted in the contemporary clinical consultation. They present a range of opportunities, but also profoundly change dynamics, working arrangements and relationships. The consultation is no longer a ‘dyad’ between clinician and patient. The EPR brings silent but highly consequential voices which shape the interaction. Where many voices meet, new questions become salient and contested. Who is doing the talking? Which voices are privileged in the consultation and why? Whose interests are served? How do clinicians allocate their attention in this crowded space, where the personal needs of individual patients jostle with the institutional ‘need’ for data? The EPR presents a significant ‘dilemma of attention’, sharpening the tension between the patient as a unique individual with a particular narrative to share (‘here and now’) and a standardised version in which the patient is ‘one of a population’ (‘there and then’). Managing this tension, which assumes different versions of the ‘self’, demands work. How this ‘work’ unfolds within the consultation contributes to how the ‘self’ is constructed and understood, and what it may be possible to achieve. The EPR contributes significantly to what it means to be a ‘professional’ or a ‘patient’ in contemporary health care.
