Imprinting Care and the Loss of Patient Narrative: Creation and Standardization of Medical Records.

BACKGROUND

Medical records manufacture a representational model of a person. Yet, little has been done to analyze the historical construction of patient charts, the deliberations in the process of their creation, and how early patient charts displaced patients' narratives.

OBJECTIVES

To retrospectively study the structure and production of old patient charts.

METHODS

Anchored by the Archives of Ontario's medical records from three 19th century psychiatric asylums-Hamilton, London, and Kingston, Canada-the paper tools are reproduced on the basis of their original manufacturing processes using cast-iron presses and relevant typesetting. This includes mirroring the process of assembly, recontextualizing the form's limitations as a function of its construction, making historical the diagnostic considerations relevant at the time, and noting the continuum of practical and operational choices that have stretched into current records.

RESULTS

An explication of the advance of physicians' objective records and the decline of the subjective patient view is given from index-card inception through design, accreditation, standardization, forms, and quantity, to analysis replacing narration.

CONCLUSION

Through this artistic work, medical paradigms become realized through paper borders. With ink, lead, and historical manufacturing, a world view is re-created. Such a marriage of medicine and art challenges the static interpretations of paper tools as only ends to the objectification of patients; instead, a tradition of reconfiguring the medical body as a thing dissolving into objectification becomes apparent. This trend continues now through the lack of narrative balancing a person's health care experience and his/her medical record.