Documenting Practices: The indexical centering of medical records

Abstract

This paper explores how organizational members use documents to share their knowledge within and across work settings. I suggest that organizational studies of distributed knowledge sharing and information systems would greatly benefit from the linguistic analysis of communicative practices. Specifically, the paper highlights the notion of indexical centering as formulated by the linguistic anthropologist William Hanks and demonstrates its analytical power in studying documenting as a communicative practice. Drawing on a 15-month, multi-sited ethnographic study in several pediatric healthcare settings, the paper focuses on how two doctors compose and use two medical histories found in two distinct medical information systems. The analysis suggests that the doctors use documents to index the temporal, spatial, and participatory dimensions of their knowledge sharing. They do so by indexing, on the one hand, the participants, times and places for their communicative practices and, on the other hand, the participants, times and places of their general care practices. The indexical analysis allows us to perceive documents, as more than mere vessels for knowledge transfer among organizational members, but as an integrated part of how people structure their work practices and situate their knowledge sharing in complex distributed organizational settings.