Abstract

In this study we argue that professionalism imposed from above can result in a type of fission, leading to the ambiguous emergence of new occupations. Our case focuses on the US’ federally mandated use of electronic health records and the increased use of medical scribes. Data include observations of 571 patient encounters across 48 scribe shifts, and 12 interviews with medical scribes and physicians in the ophthalmology and digestive health departments of a community hospital. We found substantial differences in scribes’ roles based on the pre-existing routines within each department, and that scribes developed agency in the interface between the electronic health record and the physicians’ work. Our study contributes to work on occupations as negotiated orders by drawing attention to external influences, the importance of considering differences across professional task routines, and the personal interactions between professional and technical workers.

中文翻译：

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医疗程序中的专业裂变：美国两个医院部门的医生和医师

摘要

在这项研究中，我们认为，从上面强加的专业精神可能导致某种裂变，从而导致新职业的模棱两可的出现。我们的案子侧重于美国联邦政府强制性使用电子健康记录和增加使用医疗抄写员的情况。数据包括在48个抄写员班次中对571名患者进行的观察，以及对社区医院眼科和消化系统保健部门的医学抄写员和医生的12次访谈。我们发现，根据各部门现有的惯例，医嘱人员的角色存在很大差异，并且在电子病历和医生工作之间的界面中，医嘱发达的代理人存在差异。我们的研究通过引起人们对外部影响的关注，为作为谈判定单的职业工作做出了贡献，