Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden.
Sociol Health Illn. 2021 Jun;43(5):1270-1285. doi: 10.1111/1467-9566.13294. Epub 2021 May 20.
In this article, we draw on Michael Lipsky's work on street-level bureaucrats and discretion to analyse a real case setting comprising an interview study of 30 Swedish doctors regarding their experiences of changes in clinical work following patients being given access to medical records information online. We introduce the notion of invisibility work to capture how doctors exercise discretion to preserve the invisibility of their work, in contrast to the well-established notion of invisible work, which denotes work made invisible by parties other than those performing it. We discuss three main forms of invisibility work in relation to records: omitting information, cryptic writing and parallel note writing. We argue that invisibility work is a way for doctors to resolve professional tensions arising from the political decision to provide patients with online access to record information. Although invisibility work is understood by doctors as a solution to government-initiated visibility, we highlight how it can create difficulties for doctors concerning accountability towards patients, peers and authorities.
在本文中，我们借鉴了迈克尔·利普斯基（Michael Lipsky）关于基层官僚和自由裁量权的研究，以分析一个真实的案例情境，该情境包括对 30 名瑞典医生进行的访谈研究，这些医生描述了在患者在线获取病历信息后，他们的临床工作所发生的变化。我们引入了“隐形工作”的概念，以捕捉医生行使自由裁量权来保护其工作的隐形性，这与隐形工作的既定概念形成对比，隐形工作表示除了执行工作的人之外，还有其他方使工作变得隐形。我们讨论了与记录相关的隐形工作的三种主要形式：信息省略、隐语写作和并行笔记写作。我们认为，隐形工作是医生解决因政治决策而向患者提供在线访问记录信息而产生的职业紧张的一种方式。尽管医生将隐形工作理解为政府发起的可见性的解决方案，但我们强调了它如何给医生在向患者、同行和当局负责方面带来困难。
