title: Electronic Health Records and the Disappearing Patient.
abstract: With rapid consolidation of American medicine into large-scale corporations, corporate strategies are coming to the forefront in health care delivery, requiring a dramatic increase in the amount and detail of documentation, implemented through use of electronic health records (EHRs). EHRs are structured to prioritize the interests of a myriad of political and corporate stakeholders, resulting in a complex, multi-layered, and cumbersome health records system, largely not directly relevant to clinical care. Drawing on observations conducted in outpatient specialty clinics, we consider how EHRs prioritize institutional needs manifested as a long list of requisites that must be documented with each consultation. We argue that the EHR enforces the centrality of market principles in clinical medicine, redefining the clinician's role to be less of a medical expert and more of an administrative bureaucrat, and transforming the patient into a digital entity with standardized conditions, treatments, and goals, without a personal narrative.
authors.affiliation: Department of Anthropology, Michigan State University.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Hunt
authors.affiliation: Department of Anthropology, Michigan State University.
authors.forename: Hannah S
authors.initials: HS
authors.lastname: Bell
authors.affiliation: Harvard T. H. Chan School of Public Health, Harvard University.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Baker
authors.affiliation: Department of Anthropology, Michigan State University, Centre for Aboriginal Initiatives, University of Toronto.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Howard
mesh_terms: D060432:Anthropology, Medical; D003695:Delivery of Health Care / Q000941:ethics* / Q000208:ethnology*; D057286:Electronic Health Records / Q000941:ethics*; D006801:Humans; D017009:Professional Autonomy
keywords: clinical culture change; electronic health records; ethics of care; professional autonomy; technology