Factors Affecting Physician-Patient Communication in the Medical Exam Room

The recent push towards patient-centered health care has put a greater emphasis on patient health literacy. Health literacy is influenced by communication between physicians and patients. We conducted research at a local health clinic to examine communication between physicians, patients, and interpreters that were present to assist patients with limited English proficiency (LEP). We used the framework of Distributed Cognition to broaden our unit of analysis beyond individuals to include artifacts and the physical environment. We analyze three factors influencing communication: the availability of electronic medical records (EMR), the use of paper documents, and the presence of an interpreter. The physical space and artifacts are shown to impose constraints upon interaction and the flow of information throughout the exam room. We discuss implications for redesigning medical examination rooms and information technologies to create collaborative spaces that better support physician-patient communication, enhance patient understanding, and improve health literacy.