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.

中文翻译：

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非公开：医生在患者可访问的电子健康记录信息服务中的隐形工作

在本文中，我们利用迈克尔利普斯基关于街头官僚和自由裁量权的工作来分析一个真实的案例环境，包括对 30 位瑞典医生的访谈研究，了解他们在患者获得在线医疗记录信息后临床工作发生变化的经历。我们引入了隐身 工作的概念来捕捉医生如何运用自由裁量权来保护他们的工作的不可见性，与公认的不可见工作的概念形成对比，后者表示工作由执行者以外的其他方隐藏。我们讨论了与记录有关的三种主要隐身工作形式：省略信息、隐秘写作和平行笔记写作。我们认为，隐身工作是医生解决因向患者提供在线访问记录信息的政治决定而引起的职业紧张的一种方式。尽管医生将隐身工作理解为政府发起的能见度的解决方案，但我们强调它如何给医生在对患者、同龄人和当局的问责制方面造成困难。