Professional Boundaries and Medical Records Management

Article excerpt

Curiosity about the purpose of a group with the intriguing name of the Misnomers Committee led to the discovery that, in the 1950s and early 1960s, the Medical Library Association attempted to change the name of another profession. Concerned about confusion between medical librarians and medical record librarians, MLA worked to take "librarian" out of the job title and the name of the professional organization of the other group. This column will describe those efforts, looking at them in light of the evolving interrelationship of library collections and clinical records. Furthermore, the initiative illustrates the importance to MLA of the definition of the boundaries of medical librarianship and its affiliation with other professions.

The first half-century of the history of MLA was largely determined by the medical profession. Physicians founded and led the association both to improve library collections and to develop a liberally educated medical practitioner. They engaged in library pursuits for a combination of reasons-professionalization of the medical profession, scientific advancements, and aspirations to scholarship. In addition to their efforts to distribute medical knowledge through libraries, they developed standardized tools for retrieval of all types of information, including indexes to the journal literature and organization of clinical records. The MLA members who were full-time librarians brought a divergent perspective to the association, but not until after World War II did they clearly assume leadership. MLA increasingly became a professional organization for librarians, with concerns for educational standards, career advancement, and improving the delivery of health information [1].

One of the first librarian members of MLA, Grace W. Myers of Massachusetts General Hospital's Treadwell Library, was also a pioneer in medical records management. In addition to being a force for introducing professional concerns of librarians into the affairs of MLA, she was instrumental in the founding of an association for medical record professionals. In 1912, she wrote of the link between library materials and patient records.

If there is a hospital library, records should be kept in close proximity to it, and, if possible, come under the supervision of the library. With theory and fact thus brought into close relation, an atmosphere is created of study and investigation which to the doctor has a value beyond estimate [2].

MLA leaders focused on inviting physicians to support the association, but in 1912 they also considered the possibility of including records personnel as members. Myers reported for a Committee on New Members, appointed to solicit new members from among those interested in the care of hospital records. Although the effort did not bear fruit, it did indicate a perception that medical records were relevant to the aims of the association-or at least a willingness to allow Myers to pursue her own vision. Only three of the nineteen individuals the committee approached even agreed to consider membership, but Myers recommended that the association advertise papers for the next annual meeting with topics that could awaken interest from these persons, such as "methods of cataloging hospital cases by diagnosis" and "methods of preserving hospital records" [3].

The same year, Myers started a local club of record clerks. Thirty years after the founding of MLA, the Association of Record Librarians of North America was established in 1928 to elevate the standards of clinical records in hospitals and other medical institutions. The association recognizes Myers as the inspiration and first president of the association, with a vision of a national organization for the standardization of records management [4]. In her history of MLA, Jennifer Connor contrasts the Association of Record Librarians with MLA. While MLA arose from the medical community in support of its libraries, the records society was formed by workers for occupational improvement. …