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Virtuosic craft or clerical labour: the rise of the electronic health record and challenges to physicians’ professional identity (1950–2022)
  1. Lakshmi Krishnan1,2,3,
  2. Michael Neuss4
  1. 1 Department of Medicine, Georgetown University, Washington, District of Columbia, USA
  2. 2 Medical Humanities Initiative, Georgetown University, Washington, District of Columbia, USA
  3. 3 Department of English, Georgetown University, Washington, District of Columbia, USA
  4. 4 Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Lakshmi Krishnan, Georgetown University, Washington, District of Columbia, USA; lakshmi.krishnan{at}georgetown.edu

Abstract

The electronic health record (EHR) is a focus of contentious debate, having become as essential to contemporary clinical practice as it is polarising. Debates about the EHR raise questions about physicians’ professional identity, the nature of clinical work, evolution of the patient/practitioner relationship, and narratives of technological optimism and pessimism. The metaphors by which clinicians stake our identities—are we historians, detectives, educators, technicians, or something else?—animate the history of the early computer-based medical record in the mid-to-late twentieth-century USA. Proponents and detractors were equally interested in what the EHR revealed about clinician identity, and how it might fundamentally reshape it. This paper follows key moments in the history of the early computer-based patient record from the late 1950s to the EHR of the present day. In linking physician identity development, clinical epistemological structures, and the rise of the computer-based medical record in the USA in the mid-to-late twentieth century, we ask why the EHR is such a polarising entity in contemporary medicine, and situate clinician/EHR tensions in a longer history of aspirational physician identity and a kind of technological optimism that soon gave way to pessimism surrounding computer-based clinical work.

  • medical education
  • History
  • philosophy of medicine/health care
  • Medical humanities
  • Literature

Data availability statement

Data sharing is not applicable as no data sets were generated and/or analysed for this study.

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Data availability statement

Data sharing is not applicable as no data sets were generated and/or analysed for this study.

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Footnotes

  • Twitter @TheLakshmiK, @Rochalimaea

  • Contributors LK and MN contributed equally to the planning, research and writing of this article.

  • Funding LK declares grant funding for research related to this article from the National Endowment for the Humanities.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.