Medical Futures Lab

Medical Record, 1963. Texas Medical Center Library Archives, IC18 Harris County Hospital District, box 8D, Folder 51477

Guest post by Olivia Banner

It may seem obvious that we’ve made great progress in keeping medical records since 1900. In the early nineteenth century, prior to the rise of methods for analyzing the body’s chemical properties (blood tests, e.g.), doctors relied on hands-on methods like measuring pulse and listening to breath to figure out what was wrong with patients, and they recorded little about their consultations. Doctors’ logbooks were more likely to note what a patient owed them than any relevant medical information. In the late nineteenth century, when physicians became increasingly dependent on analyzing data about the body and when early hospitals began to keep records, there were no standards in place to dictate what information about the patient to record. The information that was recorded and the form the record took were up to the discretion of individual physicians. The result? It was impossible for doctors to compare cases in a meaningful way, nor was there any way to trace back how a doctor arrived at a diagnosis.

In the early twentieth-century, the modern hospital emerged, and with it medical education programs. These two developments made standardized records a necessity. Add to these factors the 1960 integration of computers, and all the conditions were in place to produce today’s medical record. And how necessary that medical record is to modern medical practice cannot be overemphasized. It enables teaching students how to interpret patient information; tracking a patient over time; aggregating data for the purposes of better understanding health and illness — all of which seem to represent significant progress over what could come out of the spotty and random records of the nineteenth century. Electronic medical records seem to allow us to record a patient’s facts in an easily accessible and flexible format, providing us with the definitive, accurate, and objective record of the case.

Yet there’s another way of looking at the long history of medical records, and that’s to explore how patients have recorded their interactions with medicine. This history, contained in journal entries, memoirs, and creative works, does not as easily fit into a narrative of progress. These “records” instead suggest that when patients are unhappy with medical professionals, it is because their own understandings of their conditions — their subjective accounts — have been rejected in favor of the objective truth that numerical measures are thought to provide.

To address this complex, and often overlooked, history, I’m creating a digital project that will allow users to explore the history of medical records from both sides. “Visualizing the Patient, from the Past to the Future” (which will reside at Connexions) provides a historical overview of materials by which doctors, hospitals, and patients have recorded their interactions. What is lost, and what is gained, in the move to electronic records? Will there be a way for patients’ narratives to be recorded in these records? As users view the materials and ponder these questions, they can use their answers to consider the best form for electronic medical records, the best ways they can be used within the clinical setting, and their possible limitations.

When some doctors in Paris starting making movies of their surgeries in the early twentieth century, they galvanized forward-thinking American physicians to try making their own medical motion pictures when they got back home. The Parisian surgeons used their films like athletes do now, to study and improve their performance. (Remember, this was before anesthesia and antisepsis had attained the life-saving sophistication they have today – “faster” was the closest to “safer” they could get.)

What the American doctors found, however, was that the medical establishment had serious reservations about this new-fangled technology and its association with the “lower classes.” Much like the current decade-plus lag in adoption of new medical technologies, medical motion pictures had to wait about 15 years to gain traction. Eventually, movies were widely embraced in medical education, and they still are today, in digital form.

Fast forward to the mid-twentieth century, when closed-circuit television seemed to offer a new and improved form of communication and teaching. Unlike the previous resistance, this time, the medical establishment was at the front of the line, begging for government grants to try to make this new technology useful for training new physicians. Had medicine become a driver of innovation? And if so, why then, but not fifty years before?

There’s no magic answer – any real explanation would be long and complex, but the question is still worth asking: why does medicine sometimes embrace new forms of communication that might disrupt traditional knowledge hierarchies, while at other times everyone has their head in the sand? Where is medicine today, in terms of the prevalent attitude toward mobile, social, personalized media platforms? And where should we look for change?