Results:
Observation of HP’s recording of social data showed up its inadequacies.
In the following, we present the results. Having accounted for the
arbitrary nature of HP’s registration of patients´ social histories we
outline the organizational and professional barriers to recording
patients’ social circumstances. We use D in citations for ‘doctors’ and
N for ‘nurses’. Table three provides an overview of themes and
subthemes.
Arbitrary registration
During observations, we examined HP’s prior knowledge about patients’
social background. If HPs, especially doctors, did register social data,
they did not do so systematically and seldom knew about patients’ social
status or background. Furthermore, if asked about a patient’s social
background, doctors were often unable to find information in the medical
record since it might not have been entered. Moreover, if the medical
record included social data, it was rarely precise. For example, records
might describe patients as a ‘senior citizen’ (fieldnotes)
without specifying the nature of their profession.
Doctors and nurses registered medical information about patients in
their respective digital records, often ‘visiting’ them to check medical
information. While they claimed to prefer sharing social information
about patients at medical conferences, observation showed that this was
not routine. If patients’ social circumstances were brought up, this
mainly occurred in extraordinary cases such as severe alcohol abuse,
homelessness or lack of compliance.
Nonetheless, the medical record did usually indicate whether the patient
or the nearest companions were qualified healthcare professionals,
suggesting a need to be extra well-prepared to answer any medical
question. HPs sometimes searched for social information in the medical
record if communication with a patient was difficult, hoping that this
would facilitate communication. However, attempts to record and access
information about patients’ social circumstances were unstructured.