The Medical Record as Professionalizing Tool

• In Event: 343 - Section on Medical Sociology Roundtables (one-hour)
  In Refereed Roundtable: Table 08. Healthcare Professions II

Abstract

The increased commodification of care over the course of the 20th and 21st centuries has transformed health care delivery into a multi-faceted transaction involving patients, physicians, and various third parties. The sociological literature has extensively documented the professional challenges physicians have encountered in this complex healthcare landscape. Whereas much is known about how competing professional groups have contested the medical profession’s authority and autonomy, less is known of when physicians – specifically trainees – first encounter these professional challenges and how these challenges directly shape their socialization into the profession. Drawing from ethnographic and interview data collected from September 2010 to September 2013 on the Internal Medicine Service of a teaching hospital in the United States, I demonstrate one pathway by which trainees encounter these professional challenges in their daily work: the medical record. The medical record plays an essential professionalizing role – serving as a site for the emergence, and management of, professional dilemmas. Structuring interactions between physicians, nurses, insurers, and other health care actors, the medical record exposes physicians-in-training to critical professional challenges in their daily work. As inter- and intraprofessional disputes surface from (mis)use of the medical record, trainees contend with challenges to their professional dominance and autonomy in their day-to-day tasks; as they learn to navigate these dilemmas, physicians-in-training realize what “good doctoring” entails in clinical practice.

Author

• Hyeyoung Oh, City University of New York-Lehman College