Från läkarens egna minnesanteckningar till vårdapparatens kommunikationsmedium Den svenska hälso- och sjukvårdens byråkratisering mellan åren 1900 och 1986 – patientinformation mellan individ och system

Abstract: The focus in this thesis is on how medical patient records have developed and changed due to the modernization processes in the Swedish health care system during the period 1900– 1986. The processes are followed and analyzed by the written means of communication in use. These are: handwritten text by the physician; type written text produced by a new profession (the medical secretary), and lastly by computer generated text produced by a network of different occupational identities. A central point is that the different means of communication convey the patient records in different ways, hence affects what function the information had in the health care system. One of the purposes with this thesis is to give new perspectives on how seemingly trivial bureaucratic processes comprise knowledge that influences the actions taken by the involved categories: physicians, patients and health care administrators. The growing work load together with writing the patient records was supposed to take too much time from the single physician’s main task, to use the medical competence for diagnosis and treatment, and a new profession was established: the medical secretary. By introducing the type writer in the health care system, conceptions of objectivity, modernity and rationalization was linked to medical records. When the health care system further expanded, several Official Reports of the Swedish Government (Statens Offentliga Utredningar) were analyzing how to best and most rationally organize the patient documentation. When the computer was introduced the awareness of the patients’ integrity increased. One reason behind the new awareness seems to be the expanded network of different occupational identities around patients, hence the physician became only one of several professions involved in the treatment. Still a remarkable result of my investigation is that by large the patient records kept the same form during almost a century. Until 1986 the physician’s notes are in general unregulated by the law. A probable explanation is that the high status and the medical specialized competence keeps a free space for the profession and delays the legislation.