Off the record: The invisibility work of doctors in a patient‐accessible electronic health record information service

Abstract

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.

The life and death of confidentiality: a historical analysis of the flows of patient information

“…It is therefore perhaps not surprising that health professionals continue to discuss data sharing as a problem of interpersonal confidentiality (like Bente does in the opening quote)—even if they now have limited ability to control the flow of patient information. When working on integrated digital platforms, professionals may choose to refrain from datafying particularly sensitive patient information to restrict its flow, but not necessarily control the information entered into the system (Petersson and Backman 2021 ). Hence, they resort to the former regime of secrecy to deal with the technological change.…”

Embedded Strangers in One’s Own Job? Freelance Interpreters’ Invisible Work: A Practice Theory Approach

“…Research thus crucially identifies which forces prevent employers, consumers and employees from 'seeing' work that is done (Poster et al, 2016). However, these studies mainly address the external factors shadowing work, or rather work made invisible by 'others' (Petersson and Backman, 2021). Despite its richness and fruitfulness, this literature contributes less to an understanding of how the processes of work can also become a precondition for its devaluation.…”

“…This framework untangles the systems that reproduce disadvantage, contributing to the identification of structural invisibilisation factors ‘enacted on’ workers as the intersecting spatial, legal and cultural mechanisms which depreciate work (Hatton, 2017: 339). Therefore, extant scholarship approaches invisible work as made invisible by others (Star and Strauss, 1999), while it devotes less attention to work made invisible by those performing it (Petersson and Backman, 2021) or an articulation of the ways in which the organisation of work itself, besides externally enacted mechanisms, can become a precondition for its devaluation. Scholars increasingly attend to the organisation of work – processes, competencies, behaviours – as a ‘meso’ theoretical level which, in contrast with the macro-focus on structural phenomena, emphasises the socially constructed knowledge and shared understandings of work (Feldman and Orlikowski, 2011; Gherardi, 2017).…”