Physicians’ Progress Notes: The Integrative Core of the Medical Record

Jørgen P. Bansler, Erling C. Havn, Troels Sune Mønsted, Kjeld Schmidt, Jesper Hastrup Svendsen

Research output: Chapter in Book/Report/Conference proceedingArticle in proceedingsResearchpeer-review

Abstract

This paper examines physicians’ progress notes, an artifact that, in spite
of its obvious importance in the coordination of cooperative work in clinical settings, has not been subjected to systematic study under CSCW auspices. While several studies have addressed the role of the medical record in patient care, they have not dealt specifically with the role, structure, and content of the progress notes. As a consequence, CSCW research has not yet taken fully into account the fact that progress notes are coordinative artifacts of a rather special kind, an open-ended chain of prose texts, written sequentially by cooperating physicians for their own use as well as for that of their colleagues. We argue that progress notes are the core of the medical record, in that they marshal and summarize the overwhelming amount of data that is available in the modern hospital environment, and that their narrative format is uniquely adequate for the pivotal epistemic aspect of cooperative clinical work: the narrative format enables physicians to not only record ‘facts’ but also—by filtering, interpreting, organizing, and qualifying information—to make sense and act concertedly under conditions of uncertainty and contingency.
Original languageEnglish
Title of host publicationECSCW 2013 : Proceedings of the 13th European Conference on Computer Supported Cooperative Work, 21-25 September 2013, Paphos, Cyprus
EditorsOlav W. Bertelsen, Luigina Ciolfi, Maria Antonietta Grasso, George Angelos Papadopoulos
Place of PublicationLondon
PublisherSpringer Science+Business Media
Publication date2013
Pages123-142
Chapter7
ISBN (Print)9781447153450
ISBN (Electronic)9781447153467
DOIs
Publication statusPublished - 2013
SeriesProceedings of the European Conference on Computer Supported Cooperative Work
Volume13

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