September 2007

Medical records and their keepers

In the course of collecting materials, it seems inevitable that those charged with maintaining records become part of the historical documentation.

img0044.jpgI recently stumbled across two items that document the changes in managing medical records and the role their keepers play in the larger health care delivery system. The first document is a typed page summarizing key points regarding the use of medical records in court. The text is taken from the 1941 Manual for Medical Records Librarians by Edna K. Huffman. It notes that “the position of the medical records librarian is one of especial trust” and “it is her duty to ascertain that the record is properly completed.” The responsibility of the medical record librarian is to protect the “chief value of a medical record… an unbiased statement inasmuch as the doctors, interns, nurses, and others concerned in making the record at the time of the patient’s hospitalization have no interest in any subsequent litigation.”

img0046.jpgAlmost forty years later, the medical records librarian has been replaced by the medical records manager. In a 1980 article from the UMHC Monitor (a former publication of the University of Minnesota Hospital and Clinics) the activities of the medical records department are highlighted to introduce others to their important function within the health delivery system. The director at the time, John Dennis, explained “Management of information is the business we’re in. We deal with the whole life-cycle of recorded information, from the creation of the information to distribution and maintenance.” Accredited record technicians (ARTs) and Registered Record Administrators (RRAs) “ensure that all record components are accounted for” including the coding and abstracting of records for electronic storage. The message of the article concludes with stating “record and information management goes beyond the basic ‘record’ and deals with their generation and use. It is a powerful institutional tool contributing to quality patient care and increased revenue.” Indeed.


img0043.jpgMany people who are seeking treatment and advice in the health care system want to be a part of the strategy that maintains their state of wellness. Often, that involvement leads both patients and physicians to apply holistic approaches, complementary therapies, and alternative medicines. At the University of Minnesota, the Center for Spirituality and Healing is partnered with the Life Science Foundation to provide accurate information and empower the individual to make these choices regarding their health.

The University of Minnesota has a long tradition of approaching medicine from multiple vantage points. In 1888, the University established the College of Homeopathic Medicine and Surgery within the Department of Medicine. The new College of Homeopathic Medicine had been in fact the former prestigious Minnesota Homeopathic Medical College. The Medical College transferred its charter to the University in order to avoid competing with the newly formed Department of Medicine as well as to gain more prominence by being associated with the University. The measure also gained additional support for the University from the public who increasingly viewed homeopathic medicine as a preferred option to orthodox treatment methods.

By the turn of the century, the College had grown to fifteen faculty members. However, over the next decade student numbers declined. In 1909 the College of Homeopathic Medicine merged with the College of Medicine and Surgery and by 1911, the Board of Regents removed the final two chairs associated with homeopathic studies within the College of Medicine and Surgery and ceased offering a separate diploma.

Eating well

img0040.jpgThe recent issue of Scientific American looks at some of the questions related to the rise of obesity in a world still plagued by famine.

A related article in the issue focuses on nutrition and diet as part of the obesity discussion. The author details an ideal diet and then notes that this advice hasn’t changed much since first put forth by University of Minnesota physiologist Dr. Ancel Keys and Margaret Keys in their 1959 book Eat Well and Stay Well the Mediterranean Way.

Questioning photographs

img0039.jpgThe University of Minnesota has long been a leader in medical advances and technologies. Since the 1960s, the University has been synonymous with advances in transplant procedures. Prior to that, the medical school gave rise to corrective open heart procedures. Two of the men that were involved with this earlier era were C. Walton Lillehei and Richard Varco.

Lillehei’s research focused on maintaining normal oxygen levels within the blood while simultaneously operating on the heart by using an external pump and blood donor to by-pass the heart. Varco’s research along with John Lewis and Mansur Taufic investigated ways to decrease the need for oxygen by inducing hypothermia and creating a longer period necessary for by-passing the heart’s pumping action.

This picture captures a moment when these two men (Lillehei on the left, Varco on the right) are engaged in surgery. However, it does not take a heart surgeon to recognize a peculiarity in the photo. An avid viewer of Grey’s Anatomy or any other medical drama would be able to point out that the men should be wearing their masks and not letting them hang down from their necks.

The answer, however, is simple. Lillehei and Varco are performing surgery, but at the time of the photograph, the work they were doing was still in development. A majority of this work was done on laboratory dogs, as is the case in this picture (likely postmortem).

The photograph is at first simple and then complicated. It carries the weight of the researchers and their efforts and the risks and sacrifices of the subjects (both human and canine) and reminds the viewer of the give and take nature of science.

In archival terms, photographs should elicit questions regarding not only their content (as I have done above) but also their intended purpose and potential consequences. In doing so, the archivist and researcher cannot work in a vacuum. The photograph needs to be placed in its original context by using the archival sources and historical references available.