## 1 Introduction  
Organizational change is intriguing because it can disrupt existing hierarchies, such as which departmental units ascend to leadership positions [1] and the degree of inequality between demographic groups [2, 3]. Yet, in medicine, the authority physicians hold over patients has remained largely immune to decades of threatening changes, including increased bureaucratic control over their work and the availability of their medical knowledge on the Internet [4, 5]. We aim to deepen understanding of the processes that undergird this stability by examining how medical residents frame the introduction of a potential threat to their authority over patients, which is the presence of the electronic health record (EHR) during consultations. Besides disrupting and slowing down workflow [6], the EHR screen represents a potential threat that can democratize the patient-physician hierarchy because it facilitates patients' access to the technical information physicians draw upon to articulate their expertise [7]. Because residents are novices, they have the potential to operate as change agents and user in a new era of patient-physician relations, and yet any resistance by them can shed light on the mechanisms by which the status quo is reproduced. Understanding the case of medical residents and their framing of the EHR has broader implications for organizational theories. The stability of the patient-physician hierarchy echoes institutional accounts about professionals structuring conformity [8], yet contradicts newer accounts characterizing professionals as change agents [9, 10, 11, 12]. We see the curious stability of the patient-physician hierarchy as a counter case for evaluating new institutionalist accounts of professionals, specifically by showing the potential role of novice professionals in reproducing the status quo. Studying the rationales of residents for how they share the EHR screen with patients during consultations is intriguing because the case represents an instance where change should occur for several reasons. First, novice professionals like residents are more open to changes, including those that diminish their authority over clients, because their habits are less developed than their seasoned counterparts [13; 14; 15]. Second, screen sharing behaviors are not institutionalized yet because numerous practices exist (e.g., [16]), which stokes reflexivity [10]. Third, regardless of whether residents share information in the EHR with patients or not, they will likely experience a contradiction, which can jolt them into envisioning alternate futures [17]. If they share, this contradicts their supervisors who may reject sharing [18]. Yet, if they do not share, this can still pose a contradiction because medical school exposes residents to changes in the profession's values and assumptions [19], in this case sharing the EHR to level the patient-physician hierarchy. Fourth, the diffusion of the EHR into consultations is a technological disruption to the professional work setting. Technical disruptions [20], particularly to workplaces (e.g., [21]), are well-documented as reconfiguring authority relations. Altogether, residents are experiencing a scenario consistent with an \"unsettled time\" [22], whereby several cultural scripts are available to justify behavior involving the EHR screen. We are interested in examining which scripts the residents select to order their new experience [23; 24] and evaluating them within the context of newer institutional accounts of professionals. We asked residents whether they share the EHR screen with patients during consultations and to explain their reasoning. Consistent with institutional accounts predicting residents as would-be change agents, some indicated sharing the screen with patients resonated with new discourse emphasizing the leveling of the patient-physician hierarchy. However, residents in our sample also described using the EHR in ways that reproduce the patient-physician hierarchy implicitly.