Toward a Sociology of an Artifact

This article argues that the medical record is an important focus for sociological research. In medical work, the modern patient's body that Foucault has so aptly described is produced through embodied, materially heterogeneous work, and the medical record plays a crucial role in this production. It does not simply represent this body's history and geography; it is a central element in the material rewriting of these. Simultaneously, the record fulfills a core role in the production of a body politic. As the record is involved in the performance of the patient's body, it is also involved in the performance of the clinic in which that body comes to life. Finally, we argue that different records and different practices of reading and writing are intertwined with the production of different patient's bodies, bodies politic, and bodies of knowledge. As organizational infrastructure, the medical record affords the interplay and coordination of divergent worlds. Seen as a site where multiple stories about patients and organizations are at stake, including the interoperability between these stories, the medical record becomes highly relevant both analytically and politically. In The Birth of the Clinic ([1963] 1973), Foucault argues that the classical, premodern "medicine of species" required a two-dimensional table as an intermediary between the individual body and medical knowledge. The table would translate individual symptoms, yielding the true nature of the disease by showing how symptoms fit into the eternal scheme of things. Symptoms were not the disease; they were pointers to this higher truth, which merely "precipitated" in individual bodies, and which the table could decode. In contrast to the medicine of species, Foucault argues, the modem clinical gaze requires no such intermediary. Truth is no longer found and organized elsewhere in some grand nosological scheme but rather in the pathological processes of individual bodies. The gaze deciphers this truth by following the symptoms inward, eliciting signs, and differentiating the pathological reality that now is the disease.