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Medical humanities and medical informatics: an unlikely alliance? Is there a role for patients’ voices in the modern case record?
  1. R J Macnaughton,
  2. H M Evans
  1. Centre for Arts and Humanities in Health and Medicine, University of Durham
  1. Correspondence to:
 Jane Macnaughton
 CAHHM, University of Durham, Room 323, Dawson Building, Science Site, South Road, Durham, DH1 3LE;

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The modern case record and the role of the patients voice

Immanuel Kant once said “Physicians think that they do a lot for a patient when they give his disease a name”.

The individual, experiential side of medicine is nowhere more explicit than in the detailed case history upon examination. It is nowhere more ironically suppressed than in the patient record during treatment. Clinical notes must of course include the values of measurable variables—temperature, blood pressure, fluids in and out—but there seems no reason other than pressure of time (and, perhaps, a reluctance to contaminate the factually indisputable with the experientially unverifiable) to exclude from the notes first-hand expressions of the ‘inner’ natural history of disease which we may call illness. Of course, phrases such as “The patient complained of ...” may routinely appear, but it would take diligence and perhaps nerve on the clinician’s part to transcribe faithfully the patient’s attempt to convey the quality of her post-operative pain; “It feels like chewing rubber bands” was Karen Fiser’s memorable and, one suspects, despairing description given in the hope that her pain management might be better-targeted, which is to say perhaps better-conceived.1

The medical humanities calendar in the UK has two national events, the annual academic conference of the Association for Medical Humanities, and the annual conference organised by University College London. The question of writing down what patients say and feel was raised at both of these events this year. In July, Professor Brian Hurwitz gave a keynote to the AMH conference in which he reviewed how medical case notes had evolved from the 18th century and earlier up to the present day, detailing in particular the extent to which the personal has diminished as we approach the present. Hurwitz referred to a contemporary account of Severe …

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