The voices of the medical record

The medical record, as a managerial, historic, and legal document, serves many purposes. Although its form may be well established and many of the cases documented in it ‘routine’ in medical experience, what is written in the medical record nevertheless records decisions and actions of individuals. Viewed as an interpretive ‘text’, it can itself become the object of interpretation. This essay applies literary theory and methodology to the structure, content, and writing style(s) of an actual medical record for the purpose of exploring the relationship between the forms and language of medical discourse and the daily decisions surrounding medical treatment. The medical record is shown to document not only the absence of a consistent treatment plan for the patient studied but also a breakdown in communication between different health professionals caring for that patient. The paper raises questions about the kind of education being given to house staff in this instance. The essay concludes with a consideration of how such situations might be more generally avoided.     

Recall by expert medical practitioners and novices as a record of processing attention

Using recall of clinical protocols as a measure of expertise in medicine has yielded disappointingly small effects. Experiments using recall of clinical laboratory data are presented to provide an explanation. In one experiment, subjects either deliberately memorized or first diagnosed and then were incidentally asked for memory. With incidental instructions, experts recalled over twice as much data as did students, but with memorization instructions, student performance approximated that of experts. Experts also showed a large advantage over students in incidental recall of data that were not relevant to the problem solution. These results suggest that expert processing in this "discrete, independent inputs" domain requires effortful analysis with minimal reliance on default values, rather than relatively effortless pattern perception reported in highly visual areas of expertise. For this area, intentional memory is a misleading measure of expertise. However, incidental memory is a valuable measure of processing during diagnosis.     

Assessment of counselling skills development: The learning record

The RSA Certificate in Counselling Skills in the Development of Learning has emerged as a significant nationally validated course and award for staff working in post-compulsory education and training. The award encourages the uses of experiential learning and of self-assessment. The approach used to reflect on experience is the Learning Record, which is also the basis of, and mechanism for, assessment of the learner's progress. The precise nature of the Learning Record has however been unclear, since the form as well as the content is decided by the learner. Experience of approaches to the creation of Learning Records by Youth Training Scheme staff following this course suggests that they always include a diary or journal but that this may either be integral to, or separate from, the Learning Record itself. The form taken by the reflective and analytical element also varies, and the authors identify four main approaches to the creation of Learning Records adopted by learners. They suggest some principles underlying the successful compilation and use of Learning Records and commend this approach to organising reflection for experiential learning in staff training and development.     

For the record

Ocherki po istorii russkoi tserkovnoi smuty (Essays on the History of Russian Church Troubles) by Anatoli Levitin* and Vadim Shavrov, Institut Glaube in der 2. Welt, Küsnacht, Switzerland, 1978, 3 volumes in one, 1, 054 pp. plus illustrations, 50 Swiss francs.     

Setting the record straight

Translate This Darkness: The Life of Christiana Morgan. By Claire Douglas. New York: Simon &; Schuster, 1993.

A Most Dangerous Method: The Story of Freud, Jung, and Sabina Spielrein. By John Kerr. New York: Knopf, 1993.

Gods in Our Midst Mythological Images of the Masculine: A Woman's View. By Christine Dawning. New York: Crossroad, 1993.

The Fisher King and the Handless Maiden. By Robert A. Johnson. San Francisco: Harper, 1993.

Listening To Prozac. By Peter D. Kramer. New York: Viking, 1993. Gathering the Light: A Psychology of Meditation. By V. Walter Odajnyk. Boston and London: Shambhala, 1993.

Gathering to Light A Psychology of Meditation

The Pornographer's Grief and Other Tales of Human Sexuality. By Josqjh Glenmullen. New York: HarperCollins, 1993. Love and the Soul: Psychological Interpretations of the Eros and Psyche Myth. By James Gollnick. Ontario: Wilfrid Laurier University Press, 1992.

Healing and Transformation in Sandplay. By Ruth Amman. Peru, IL: Open Court, 1991.

Hildegard of Bingen and Her Vision of the Feminine. By Nancy Fierro. Los Angeles: Carondelet Productions, 1994