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.
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- 1.
For a kindred study of the discharge letter, cf. Winthereik and Vikkelsø (2005).
- 2.
All names, dates, and other identifying information have been changed.
- 3.
At the time of the study, progress notes at the hospital in question were dictated digitally by the physician, typically immediately after examining the patient, for instance upon admission or during a ward round, and later typed by a medical secretary, printed out, and added to the patient’s medical record (today they are also available in electronic form). The notes are usually recorded daily, but for patients in critical care, notes are typically made several times a day.
- 4.
Amiodarone is the active ingredient in Cordarone (and other brand name drugs). In this context it is to be taken as a synonym of Cordarone.
- 5.
Advanced Life Support (ALS) is an emergency procedure performed to manually support breathing and circulation with the aim of preserving intact brain function until the patient has a return of spontaneous circulation (ROSC) or is declared dead.
- 6.
The excerpts from the progress notes have been translated from Danish by the authors.
- 7.
An oral anticoagulant. Marevan is the Danish brand name for this drug (Warfarin).
- 8.
The scale provides a score in the range 3–15, in which progressively higher scores indicate higher levels of consciousness. Patients with scores of 3–8 are usually said to be in a coma.
- 9.
The QT interval is measured on an electrocardiogram (ECG).
- 10.
DC (Direct Current) cardioversion is a medical procedure by which a cardiac arrhythmia is converted to a normal rhythm, using electricity. It is performed by giving the heart an electric shock, at a specific moment in the cardiac cycle. In contrast, pharmacologic cardioversion, uses antiarrhythmia medication instead of an electrical shock.
- 11.
The study did not focus exclusively on the progress notes, but on the traditional medical record as a whole, that is, including lab reports, X-rays, etc. contained in the patient’s folder.
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Acknowledgments
The research was supported by the Danish Council for Strategic Research as part of the CITH project (2008–2012). Technicians and cardiologists at Rigshospitalet and Bispebjerg Hospital participated in the project, and their essential contribution is gratefully acknowledged.
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Bansler, J., Havn, E., Mønsted, T., Schmidt, K., Svendsen, J.H. (2013). Physicians’ Progress Notes. In: Bertelsen, O., Ciolfi, L., Grasso, M., Papadopoulos, G. (eds) ECSCW 2013: Proceedings of the 13th European Conference on Computer Supported Cooperative Work, 21-25 September 2013, Paphos, Cyprus. Springer, London. https://doi.org/10.1007/978-1-4471-5346-7_7
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