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Disciplined doctors: The electronic medical record and physicians' changing relationship to medical knowledge

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  • Reich, Adam

Abstract

This study explores the effects of the electronic medical record (EMR) on the power of the medical profession. It is based on twenty-five in-depth interviews with administrators and physicians across three departments of a large, US integrated health system, as well as ethnographic observation, all of which took place between September of 2009 and December of 2010. While scholarship on professional power has tended toward the opposite poles of professional dominance and deprofessionalization or proletarianization, I find that doctors' interactions with the EMR reconcile these perspectives by making physicians' professional identities consistent with their subordination to bureaucratic authority. After examining the electronic medical record as a disciplinary technology, the paper analyzes variation in the extent to which practitioners' professional identities are reconciled with bureaucratic subordination across the different departments studies.

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  • Reich, Adam, 2012. "Disciplined doctors: The electronic medical record and physicians' changing relationship to medical knowledge," Social Science & Medicine, Elsevier, vol. 74(7), pages 1021-1028.
    • Handle: RePEc:eee:socmed:v:74:y:2012:i:7:p:1021-1028
    DOI: 10.1016/j.socscimed.2011.12.032
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    References listed on IDEAS

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    1. Berg, Marc, 1997. "Problems and promises of the protocol," Social Science & Medicine, Elsevier, vol. 44(8), pages 1081-1088, April.
    2. Lambert, Helen, 2006. "Accounting for EBM: Notions of evidence in medicine," Social Science & Medicine, Elsevier, vol. 62(11), pages 2633-2645, June.
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    Cited by:

    1. Claudio Vitari & Roxana Ologeanu-Taddei, 2018. "The intention to use an electronic health record and its antecedents among three different categories of clinical staff," Post-Print halshs-01923238, HAL.
    2. Andrei M. Korbut, 2016. "Electronic Health Records and Clinical Routines: Convergence and Divergenc," HSE Working papers WP BRP 130/HUM/2016, National Research University Higher School of Economics.
    3. Carboni, Chiara & Wehrens, Rik & van der Veen, Romke & de Bont, Antoinette, 2022. "Conceptualizing the digitalization of healthcare work: A metaphor-based Critical Interpretive Synthesis," Social Science & Medicine, Elsevier, vol. 292(C).
    4. Altomonte, Guillermina, 2022. "Coordinating illness and insurance trajectories: Evidence from a post-acute care unit," Social Science & Medicine, Elsevier, vol. 308(C).
    5. Cherif, Emna & Bezaz, Nora & Mzoughi, Manel, 2021. "Do personal health concerns and trust in healthcare providers mitigate privacy concerns? Effects on patients’ intention to share personal health data on electronic health records," Social Science & Medicine, Elsevier, vol. 283(C).
    6. Gleeson, Shannon, 2012. "Leveraging health capital at the workplace: An examination of health reporting behavior among Latino immigrant restaurant workers in the United States," Social Science & Medicine, Elsevier, vol. 75(12), pages 2291-2298.
    7. Menchik, Daniel A., 2014. "Simmel's dynamic social medicine: New questions for studying medical institutions?," Social Science & Medicine, Elsevier, vol. 107(C), pages 100-104.
    8. Petrakaki, Dimitra & Klecun, Ela & Cornford, Tony, 2016. "Changes in healthcare professional work afforded by technology: the introduction of a national electronic patient record in an English hospital," LSE Research Online Documents on Economics 59475, London School of Economics and Political Science, LSE Library.
    9. Vale, Mira D. & Perkins, Denise White, 2022. "Discuss and remember: Clinician strategies for integrating social determinants of health in patient records and care," Social Science & Medicine, Elsevier, vol. 315(C).
    10. Claudio Vitari & Roxana Ologeanu-Taddei, 2018. "The intention to use an electronic health record and its antecedents among three different categories of clinical staff," Grenoble Ecole de Management (Post-Print) halshs-01923238, HAL.

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