Records as phenomena: the nature and uses of medical records
In Chapter I, the approach taken to the study of records is introduced. Sociologists and historians treat records as only contingently true. However, they do not explicate the source of the contingency. They do not address the basic idea of records which makes the contingency possible. The notion that records are only contingently true stems from a conception of fact as a relation between record and event which parallels a conception of language as a relation of words to things. The event is supposed to produce the record but the record (and recorder) are not supposed to produce the event. Various practical problems with records stem from the need to produce this asymmetric record-event relationship. In Chapter II, an investigation is begun of how the record-event relationship is achieved. It is achieved by the action of "observation". Observation requires an observer's presence but it also requires that the observer's presence not make a difference to the event. If the observer's presence does not make a difference, his record can be analytically identical with the event and therefore the event can be known through the record. The observer's presence is supposed to rid speech of its opinionated character. By being present, the observer need not speak in an opinionated way. He can be a "witness" to the world which speaks for itself. .ua present witness, what the observer can know is time-bound and place-bound. He can know only the "present" time and the "present" place. Records are the kind of Speech observers produce about the present, speech which does not affect things but merely "notes" things. Given that observers can know only the present, records become necessary in order to grant permanence to an observer's kind of knowledge. In Chapter III, the observer-recorder's concept of the present is further investigated. The present in the sense that it can be known is not a moment in time; it is an appearing, self-disclosing thing. Recording, then, presupposes a particular definition of things: things are appearances. Because the event is thought to present itself, the observer need not contribute to it. To say that the observer can see only the present is not to limit the observer to the "physical". It is to limit the observer to anything which can present itself. Finally, it is suggested that the notion that observers can see only one thing at a time can be accounted for in terms of the grounds of observation. The observer sees just one thing at a time since his notion of a thing is analytically identical to his notion of a time. In Chapters IV and V, an attempt is made to apply the analysis of the grounds of records to problems involved in the use of records by hospital bureaucrats. Bureaucrats seeking to use records face a problem in that they were not present when the records were made (and the event happened) and therefore would seemingly have nothing that is not opinionated speech to say about the record. The bureaucrat's solutions to the problem involve putting his own speech at the service of the record just as the observer puts his speech at the service of the event. The first specific solution is discussed in Chapter IV: bureaucrats can subjugate their speech and know events indirectly by "relying" on observers, thereby achieving analytic identity with observers. Concern with reliability on the part of bureaucrats (and sociological methodologists) is explained in terms of the basic grounds of observation. It is shown in some detail that bureaucrats do in fact attempt to ensure that "reliable" records are produced. In Chapter V, the topic is shifted from reliability to completeness. Hospital administrators are concerned with the completeness of records rather than their accuracy. However, the concern with completeness i: not an example of goal displacement since, through the concern with com.leteness, bureaucrats manage to control their own speech, thus attaining the self-same lack of participation that observers attain. By evaluating records in terms of completeness, bureaucrats turn the record into an appearing thing, thus attaining a kind of presence with it. In the conclusion, two implications of our study for further work are developed. 1. Empirical analysis must be seen not simply as a method for finding'; out whether theories are correct since the very idea of beint empirical precludes even asking some ii portant theoretical questions. 2. Just as record-writing can be thought of as an idea which requires grounds, the speech of social theorists can be thought of as requiring a method. A brief attempt is made to "produce" the speech of Goffman and Garfinkel.