从规则、媒介和患者角度对病历的批判性考察

A Critical Exploration on Medical Records from Perspectives of Rule, Media and Patient

作为一种档案文体,病历既是规则范式也是媒介范式。标准病历成熟的规则性,体现了近代以来医疗知识专业化、体系化的要求,其背后有深刻的社会经济动因。平行病历具有突出的媒介性,试图引入人文科学以弥合医学领域中认识型之间的裂痕。其内核在于,利用文本的隐喻性,敞开医疗过程中为现有科学话语所遮蔽的内容,进而在实践中对医患双方起到净化与疏泄的作用。从前现代病历,标准病历再到平行病历,病历发展变动的核心在于如何合理地对待病人的声音,而这一要义未来很可能会促进平行病历与标准病历的融合。

As an archive writing,medical record is either a normalized paradigm or a media paradigm.The standard writing rules of medical records reflect the specialization and systemization of modern medicine,which have profound social and economic motivations behind.With its prominent feature as media,parallel medical records try to introduce humanities to medical field to fill the gap between epistemes.Its core value lies in the metaphoricity of texts to reveal the implicit contents in medical discourse and then to purify and relieve both doctors and patients.From pre-modern medical record,standard medical record,to parallel medical record,the essence of these developments and changes lies in how to deal with patients'voices reasonably,and this essential understanding is quite possible to promote the integration of parallel medical record and standard medical record in the future.