title: En-case-ing the patient: disciplining uncertainty in medical student patient presentations.
abstract: The problem-oriented medical record is the widespread, standardized format for presenting and recording information about patients, which is taught to future physicians early in their medical training. Based on our participant observation of medical training, we analyze the ways in which the patient presentation operates in medical training as a disciplinary technology that manages uncertainty in the clinical decision-making process. We uncover various mechanisms at work including the construction of a coherent narrative structure in which chaotic experiences are re-organized and re-interpreted to fit neatly in a linear plot with a predictable ending, the atomization of the patient as a whole into separable "problems," the attempt to solve these "problems" as though they are independent of one another, and the mystification of translations in scale, which give rise to much of the uncertainty in medicine. Operating at the boundary of the chaotic and often ungraspable world of the suffering experience of the patient and the highly structured realm of the medical record, a patient presentation is one medium through which both a disciplined record of experience and disciplined medical practitioners are produced. This process functions to transform the human subject patient into a recognizable, generic clinical case, and the medical student into an identifiable, professional future physician.
authors: Program in Health and Social Behavior, University of California, 50 University Hall, MC 7360, Berkeley, CA 94720-7360, USA. sethmholmes@berkeley.edu
authors: Seth M
authors: SM
authors: Holmes
authors: Maya
authors: M
authors: Ponte
references: Soc Sci Med Med Anthropol. 1980 Feb;14B(1):3-13
references: 7394562
references: N Engl J Med. 1968 Mar 14;278(11):593-600
references: 5637758
references: Cult Med Psychiatry. 2008 Jun;32(2):238-58
references: 18299968
references: N Engl J Med. 2004 Feb 26;350(9):862-4
references: 14985483
references: Can Fam Physician. 2007 Aug;53(8):1265-7
references: 17872831
references: Milbank Q. 2002;80(2):237-60
references: 12101872
references: Milbank Mem Fund Q Health Soc. 1980 Winter;58(1):1-49
references: 6903782
references: J Health Soc Behav. 1988 Dec;29(4):357-75
references: 3253326
references: J Health Soc Behav. 1988 Dec;29(4):323-32
references: 3253323
references: N Engl J Med. 1971 Jan 7;284(1):51-2
references: 5538590
references: Br Med J. 1978 Jun 24;1(6128):1686-7
references: 306857
references: Acad Med. 2001 Jun;76(6):620-1
references: 11401806