Virtuosic Craft or Clerical Labour: The Rise of the Electronic Health Record and Challenges to Physicians’ Professional Identity (1950–2022)

Article Summary by Lakshmi Krishnan and Michael J. Neuss

What is the work of physicians? Are we historians, detectives, magicians, or educators? Or is our craft merely clerical work, our labor just data entry for other users—both human and non-human, intelligent and artificially intelligent—in non-clinical areas like finance and research? Physicians today express deep anxieties about the nature of their work, and often worry about how the electronic health record (EHR) impacts their professional identity. Our paper examines the history of such anxieties from the 1950s onwards, and the metaphors that physicians have used to describe their work. Computers have changed physicians’ work in important ways, but anxieties about the computer-based patient record (eventually known as the EHR) express a deeper angst about physicians’ privileged place in the medical hierarchy, and the apparent challenge to physicians’ authority the computers have represented. Despite the ubiquity of flattering metaphors like the physician as detective, magician, or virtuoso, we argue that physicians’ work is often much more mundane. The work is modest but essential—less about feats of diagnostic brilliance—and grounded more often in highly practiced and at times diligent (if repetitive) tasks.

We were also pleased to share our work on two episodes of the podcast Bedside Rounds, which can be accessed here:



Read the full article on the Medical Humanities journal website.


Portrait photograph of Lakshmi Krishnan.Lakshmi Krishnan is a cultural historian of medicine and physician at Georgetown University, where she is the Founding Director of the Georgetown Medical Humanities Initiative. Her forthcoming book The Doctor and the Detective (Johns Hopkins University Press) focuses on the cultural history of diagnosis and the kinship between doctors and detectives.







Portrait photograph of Michael J Neuss.Dr. Neuss is a practicing physician and historian of science and medicine at the University of Pennsylvania, where he is an Assistant Professor of Clinical Medicine in the Section of Hospital Medicine. His current research focuses on the history of the computer-based patient record.

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