The Use of Narratives in Medical Work: A Field Study of Physician-Patient Consultations

Abstract

Medical reasoning involves more than just summarizing clinical data and guidelines. Illness trajectories of chronic patients are often long, complex and full of uncertain information that requires interpretation. Understanding the complex interrelations is an important aspect of medical reasoning that displays narrative rather than scientific characteristics. While the qualities of the medical record as a repository of information or as a coordinative tool are well known, the role it plays in the unfolding of narratives in medical reasoning is less discussed. This paper examines this issue through a case study of patient consultations that take place as part of a distributed treatment of chronic heart patients. We found that the record, even though fragmented and to some extent incomplete, enables the physician to construct an ad hoc narrative. During the actual consultation, physicians and patients unfold a more detailed narrative, which we refer to as the re-emplotted narrative, that includes additional information and entails a collaborative exploration of uncertainties. While this may point to some inadequacies of the medical record as a supportive tool for the process of unfolding narrative, we suggest that is it in fact a crucial component of the medical reasoning activity that must be considered in design of supportive systems.