Imprinting Care and the Loss of Patient Narrative: Creation and Standardization of Medical Records.

BACKGROUND: Medical records manufacture a representational model of a person. Yet, little has been done to analyze the historical construction of patient charts, the deliberations in the process of their creation, and how early patient charts displaced patients' narratives.
OBJECTIVES: To retrospectively study the structure and production of old patient charts.
METHODS: Anchored by the Archives of Ontario's medical records from three 19th century psychiatric asylums-Hamilton, London, and Kingston, Canada-the paper tools are reproduced on the basis of their original manufacturing processes using cast-iron presses and relevant typesetting. This includes mirroring the process of assembly, recontextualizing the form's limitations as a function of its construction, making historical the diagnostic considerations relevant at the time, and noting the continuum of practical and operational choices that have stretched into current records.
RESULTS: An explication of the advance of physicians' objective records and the decline of the subjective patient view is given from index-card inception through design, accreditation, standardization, forms, and quantity, to analysis replacing narration.
CONCLUSION: Through this artistic work, medical paradigms become realized through paper borders. With ink, lead, and historical manufacturing, a world view is re-created. Such a marriage of medicine and art challenges the static interpretations of paper tools as only ends to the objectification of patients; instead, a tradition of reconfiguring the medical body as a thing dissolving into objectification becomes apparent. This trend continues now through the lack of narrative balancing a person's health care experience and his/her medical record.