Hospital physicians must navigate through vast quantities of patient information represented in text-based reports. Although intended to improve patient care, their effectiveness hinges on each physician’s ability to successfully handle and interpret fragmented information from diverse sources. The increasing automation of text interactions are a potential support but are still at the early phase of implementation in real-world scenarios. We observed 144 hours of clinical shifts in a German internal medicine hospital and collected structured field notes on physicians’ current practices with text-based reports to enrich existing understanding of the requirements for including automation to clinical text. We identified medical discharge letters as most frequently consulted text document and a qualitative analysis of the field notes revealed that this document acts as a key artifact that serves different roles and purposes in the hospitalization of a patient. Based on our findings we discuss possible loss of these nuanced uses through automation and propose design implications for medical text reports.