Exploring the Patient's Lifeworld: A Qualitative Study of Personalizing Language in Electronic Health Records.

Abstract

Physicians' understanding of patients as persons can bolster relationships and help patients feel seen. Including personal details in electronic health records (EHR) may enhance care, but the types of details physicians document about patients' lifeworlds remain largely uncharacterized. To assess the prevalence and types of personalizing language written by physicians in clinical encounter notes. Cross-sectional qualitative content analysis of physician-written history and physical (H&P) notes. Adult patients admitted to the internal medicine inpatient service at an urban academic tertiary care hospital. We performed an inductive content analysis of H&P notes. Two authors independently coded instances of personalizing language: details about patients' unique identities, social context, life experiences, and perspectives. The study team met periodically to discuss examples and categories and compare assessments until thematic saturation was reached. We summarized the prevalence of personalizing language and described its content. We reviewed 570 H&P notes written about 437 unique patients (median age 57; 53% Black, 38% White; 54% male) by 186 physicians. More than half of notes (60%) contained at least one instance of personalizing language (median 2, range 1-7 per note). We identified 840 instances of personalizing language across seven domains: family (41%), work/education (32%), residence (21%), personal interests (2.9%), pets (1.8%), travel (0.6%), and goals/priorities (0.6%). Nearly half (47%) referred to general social context; 51% provided more detailed information. Only 1.9% described patients' thoughts, feelings, or goals. Personalizing language was more commonly used in notes for men vs women (70% vs 60%, p = 0.02). Most H&P notes included personalizing language, though many provided limited detail and very few described patients' interests, goals, and priorities. Future studies should evaluate patient perceptions of personalizing language in the medical record and its impact on physician attitudes towards and relationships with patients.