On the Narrativity, History, and Ethics of an Unknown Genre of Medical Communication
Despite its ubiquity, the medical discharge report/letter has received no sustained scholarly attention as a genre in its own right. Yet, physicians read, write, and rely on this crucial document countless times over the course of their careers: for every patient released from hospital, a letter is produced that condenses the complex clinical trajectory—diagnoses, interventions, complications, and recommendations—into a compressed narrative form. This form is dictated as much by institutional convention and medico-legal necessity as it is by clinical reasoning, and it circulates between hospitals, general practitioners, insurers, and patients themselves, shaping how illness is understood, communicated, and acted upon beyond the walls of the hospital. This project explores the narrativity, history, and ethics of a standardized, epistemic genre that organizes written medical communication worldwide. Given that the discharge report has not yet been subjected to scholarly investigation in the humanities, our project establishes the first state of the art in this field.
From Narrative to Norm
Our sources from both Swiss and German state and hospital archives indicate that the genre gradually developed during the 20th century: In the first part of the century, when letters from physicians to colleagues sporadically appear in medical files, illnesses are described in a rather subjective, narrative, even literary manner. After the mid-century, the discharge report appears more and more formalized and a necessary element of the patient file.
This historical trajectory seems to reflect developments in clinical medicine toward pluralism and specialization, as well as rapid technological development. Finally, it raises ethical questions about patients’ experiences in hospitals and about medical communication in general.
Three Aims––One Project
Cultural History & Literary Studies How physicians argue and reason narratively within the genre of the medical discharge report
History of Medicine How the discharge report has evolved historically––in conjunction with the changing role of the hospital over the course of the 20th century, in relation to the patient record, and in relation to the institutional structures of health insurance
Medical Ethics How the discharge report negotiates fundamental conflicts concerning paternalism, technology, and the principles of medical ethics, from a historical and systematic perspective.
Project Duration 8/2025 – 7/2029
News
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Agnes @ the ICCEC 2026
Agnes Kandlbinder presented parts of her research on hospital discharge letters at this year’s International Conference on Clinical Ethics Consultation (ICCEC) in Cleveland. Based on a document analysis of historical letters, the presentation prompted a joint reflection on the historical lineage of medical documentation, and on what practices, formats, and approaches could best serve patients…
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Sophie @ UNIL Day 2026
Sophie Püchel, the project’s PhD researcher in the ethical branch of the project, presented her recent work on a scoping review on “Artificial Intelligence in Clinical Documentation“ at Université de Lausanne at the AI@UNIL Day 2026. Emerging evidence points to AI having the potential of saving time and increasing efficiency in everyday clinical administrative tasks––but…
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Agnes and Sophie @ the Societé Suisse d’éthique biomedicale
Agnes Kandlbinder and Sophie Püchel, together with colleagues from the Institut des humanités en médecine UNIL-CHUV, took part in the winter seminar of the Société Suisse d’éthique biomédicale, held in January 2026, in the beautiful setting of Bigorio, Ticino. This year’s seminar focused on the topic of health equity in Switzerland. Agnes and Sophie presented initial…