Keeping Track of Speaker's Perspective: The Role of Social Identity

Through the Narrative Looking Glass: Commentary on “Impact of Electronic Health Records on Information Practices in Mental Health Contexts: A Scoping Review” (Preprint)

The authors of “Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review” have effectively brought to our attention the failure of the electronic health record (EHR) to represent the human context. Because mental health or behavioral disorders (and functional status in general) emerge from an interaction between the individual’s characteristics and the social context, it is essentially a failure to represent the human context. The assessment and treatment of these disorders must reflect how the person lives, their degree of social connectedness, their personal motivation, and their cultural background. This type of information is best communicated both through narrative and in collaboration with other providers and the patient—largely because human social memory is organized around situation models and natural episodes. Neither functionality is currently available in most EHRs. Narrative communication is effective for several reasons: (1) it supports the communication of goals between providers; (2) it allows the author to express their belief in others’ perspectives (theory of mind), for example, those who will be reading these notes; and (3) it supports the incorporation of the patient’s personal perspective. The failure of the EHR to support mental health information data and information practices is, therefore, essentially a failure to support the basic communication functions necessary for the narrative. The authors have rightly noted the problems of the EHR in this domain, but perhaps they did not completely link the problems to the lack of functionality to support narrative communication. Suggestions for adding design elements are discussed.

Parents accidentally substitute similar sounding sibling names more often than dissimilar names

When parents select similar sounding names for their children, do they set themselves up for more speech errors in the future? Questionnaire data from 334 respondents suggest that they do. Respondents whose names shared initial or final sounds with a sibling’s reported that their parents accidentally called them by the sibling’s name more often than those without such name overlap. Having a sibling of the same gender, similar appearance, or similar age was also associated with more frequent name substitutions. Almost all other name substitutions by parents involved other family members and over 5% of respondents reported a parent substituting the name of a pet, which suggests a strong role for social and situational cues in retrieving personal names for direct address. To the extent that retrieval cues are shared with other people or animals, other names become available and may substitute for the intended name, particularly when names sound similar.