Informatics tools and medical communication: patient perspectives of "knowledge coupling" in primary care.

The use of various "informatics tools" for routine patient care promises to radically alter the ways whereby medical knowledge and information are processed and applied. In so doing, it can also change the nature of the information exchange and relational communication that occurs between patients and caregivers. This investigation examines how patients view "knowledge coupling" (KC) tools as they are routinely used in a "coupler-centered" family practice (CCP). How do patients view these tools as influencing information exchange and their relationship with caregivers? Based upon close- and open-ended questions of a random sample of patients in the CCP, this study found that most respondents viewed KC informatics tools as elevating the information exchange that occurs between patients and caregivers-increasing the extent to which patients are "heard and understood" by caregivers and come to "know and understand" what is ailing them. Many respondents report being empowered by the use of the tools, and having greater confidence in the care and advice caregivers offer. A few others, however, suggest diminished confidence in care and a more "impersonal" environment, resulting specifically from the use of the computer in the office. The article concludes by suggesting ways whereby such deficiencies might be remedied.