Unpacking Exam-Room Computing: Negotiating Computer-Use in Patient-Physician Interactions

摘要

The presence of computers - especially desktops - takes significant time and attention away from patients during medical visits. As a result, patients may feel disengaged and disregarded. In this study, we examined the impact of using "Computer-on-Wheels" (COWs) in exam-rooms. We found physicians constantly reorienting and resituating exam-room computers to different positions during the three stages of a medical visit: communication-intensive phase, lecturing phase and ordering phase. We refer to this behavior as micro-negotiation of computer-use. Analysis of its usage patterns, as well as physician and patient perceptions, show that micro-negotiations facilitate eye contact expression and encourage patient participation in medical visits. In addition, we identify two tensions and two unintended benefits resulting from micro-negotiations. These findings lead us to consider new modes of negotiation in the exam-room that could alleviate the tensions identified while enabling physicians to continue enjoying micro-negotiation benefits in their work practice.