The impact of documentation on communication during patient-physiotherapist interactions: A qualitative observational study

Abstract

Documentation is an essential component of physiotherapy practice for clinical, legal, and ethical reasons. Research in other healthcare contexts suggests that documentation impacts upon communication in patient-practitioner interactions. Thus, the objective of this qualitative study was to examine how physiotherapists and their patients communicate during episodes of documentation. The research was informed by ethnomethodology and ethnography. In total, 113 patient-physiotherapist interactions were observed in Switzerland and Australia with video-recordings, audio-recordings, and field notes collected as data. Episodes of documentation within these interactions were transcribed, and both verbal and non-verbal communication were analyzed inductively. Analysis identified that communication during documentation was characterized by: pauses in conversation, pre-established order of questioning, minimal eye contact, use of direct communication, and an emphasis on objectivity. The use of documentation was observed to alter the wording of questioning as well as the sequence and flow of conversation between patient and physiotherapist. In addition, the observed communicative features seemed to restrict patient participation, and may hinder the achievement of a patient-centered approach. Recognizing the importance of documentation, we address the challenges that our research highlighted by proposing strategies to assist educators and clinicians to optimize communication with patients when incorporating documentation into practice.

How do physiotherapists solicit and explore patients’ concerns in back pain consultations: a conversation analytic approach

“…physiotherapy (Schoeb and Hiller, 2018) interactions, and in the data presented here appeared to curtail opportunities for patients to develop their perspectives and 'voice' their underlying concerns.…”

Physiotherapists’ Approaches to Patients’ Concerns in Back Pain Consultations Following a Psychologically Informed Training Program

“…Using documentation during the interaction is a widely recognized barrier to effective communication (Cowell, McGregor, et al, 2019; Schoeb & Hiller, 2018). In these findings, the physiotherapists’ sensitivity to the intrusive nature of documentation was manifest in their body comportment and eye gaze away from the documentation and toward the patient (Robinson, 1998).…”

“…We also observed in these findings how physiotherapists integrated documentation tools to limit their intrusive nature when addressing patients' concerns. Being able to integrate physiotherapy documentation to limit its intrusive nature when addressing patients' concerns may be difficult in current practice given an increasing move toward the use of computerized documentation (Schoeb & Hiller, 2018). It has been suggested that the structure of documentation tools may need reconsideration so that they align more seamlessly with the flow of the conversation (Schoeb & Hiller, 2018).…”

Evaluation of conventional lecture method versus PBL (Problem Based Learning) using the cases notes prepared by new graduates.

“…Various departments have now devised their own specific performa which has sections to be filled with key history points. [2][3][4][5] Problem based learning (PBL) in various ways has become popular in medical schools over the past few years. There was serious division seen between the supporters and the skeptics when the teaching patterns was switched for the first time, and serious concerns were seen regarding the quality and level of knowledge being conveyed to the students.…”