Rationalizing Medical Work: Decision Support Techniques and Medical Practices / Edition 1by Marc Berg
Pub. Date: 04/04/1997
Publisher: MIT Press
"Is medicine a science or an art? Marc Berg's contribution to this long-standing debate moves away from normative arguments replacing them with an ethnographic inquiry that goes to the heart of medical work. Berg's analysis leads to a provocative new understanding of the practice of medicine and of medical judgment, grounded in a detailed
"Is medicine a science or an art? Marc Berg's contribution to this long-standing debate moves away from normative arguments replacing them with an ethnographic inquiry that goes to the heart of medical work. Berg's analysis leads to a provocative new understanding of the practice of medicine and of medical judgment, grounded in a detailed empirical account rather than simplistic generalizations."One response to the current crisis in medicine--indicated by large variations in practice and skyrocketing costs--has been a call for the rationalizing of medical practice through decision-support techniques. These tools, which include protocols, decision analysis, and expert systems, have generated much debate. Advocates argue that the tools will make medical practice more rational, uniform, and efficient: that they will transform the "art" of medical work into a "science." Critics within medicine, as well as those in philosophy and science studies, question the feasibility and desirability of the tools. They argue that formal tools cannot and should not supplant humans in most real-life tasks.
-- Alberto Cambrosio, Department of Social Studies of Medicine, McGill University
"This book is an outstanding contribution to STS scholarship and the study of sociotechnical practices. Berg's key conceptual theme, and the sharp, subtle, and sophisticated inferences he draws from his data, will stimulate other scholars to explore the generality of his insights beyond the field of medical practice. Berg's eclectic ability to interrelate different perspectives enhances the theoretical payoff of his case study. This book will be a tour de force that technology-studies scholars and others will refer to over and over again in thinking about how to conceptualize and linguistify human-machine interfaces."
-- Mark A. Shields, Division of Technology, Culture, and Communication, University of Virginia
Marc Berg takes the issues raised by advocates and critics as points of departure for investigation, rather than as positions to choose from. Drawing on insights and methodologies from science and technology studies, he attempts to understand what "rationalizing medical practices" means: what these tools do and how they work in concrete medical practices. Rather than take a stand for or against decision-support techniques, he shows how medical practices are transformed through these tools; this helps the reader to see what is gained and what is lost.
The book investigates how new discourses on medical work and its problems are linked to the development of these tools, and it studies the construction of several individual technologies. It looks at what medical work consists of and how these new technologies figure in and transform the work. Although the book focuses on decision-support techniques in the field of medicine, the issues raised are relevant wherever rationalizing techniques are being debated or constructed. Touching upon broader issues of standardization, universality, localization, and the politics of technology, the book addresses core problems in medical sociology, technology studies, and tool design.
Inside Technology series
Table of ContentsPreface
CHAPTER 1 · The Withering Flower of Our Civilization:
Reconceptualizing Postwar Medical Practice
Early Postwar Medical Practice: Its Nature and Problems
The Science and the Art of Medicine
The Problems of Medical Practice
The Multiple Sciences of Medical Practice
Situating Science as the Foundation of Practice
Situating Science in the Structure of Medical Action
A Turn to the Mind: New Sciences of Medical Practice
A Turn to the Mind: New Problems and solutions
New Practices, New Problems, New Solutions
CHAPTER 2 · Multiple Rationalities: The Different Voices
of Decision Support Techniques
The Quest for Objective Inference: The Statistical Tools
Clinical Decision Analysis: Reshaping the Statistical Tool
Different Tools, Different Practices, Different Rationalities
Capturing the Clinic: The Protocol
The Haze of Bayes and the Aerial Palaces of Decision Analysis:
A Criticism of Statistical Reasoning
The Clinical Grounding of the Protocol
The Statistical Countercritique; the Development of Consensus
EXpert Systems: the Best of Both Worlds?
An Early Promise: MYCIN
The EXpert System: Encoding Clinical Reasoning
The Statistical CounterCritique Revisited: Later Generation
CHAPTER 3 · Getting a Tool to Work: Disciplining a Practice
to a Formalism
Disciplining the Practice to a Formalism
The Story of ACORN
Building Simple, Robust Worlds
Reinforcing Bureaucratic Hierarchies
Materializing the Tool's Demands
Reshuffling Spokesmanship: Shifting Decision Power amongst
ChangingPractices: the Specific EXigencies of a Formal Tool
CHAPTER 4 · Of Nodes, Nurses and Negotiations: The Localization
of a Tool
"In light of these concerns this guideline seems crazy"
Localization: "One Starts with Great EXpectations"
Changing Practices: Decreasing Diversity?
Of Nodes, Nurses and Negotiations: Some Conclusions
CHAPTER 5 · Supporting Decision Support Techniques: Medical Work
and Formal Tools
Medical Work: The Heterogeneous Management of Patients' Trajectories
Medical Work as Distributed Work
Formal Tools and Medical Work
The RealTime Work of Making Tools Work
(Re)constructiing Medical Data
The RealTime Work of Making Tools Work: Some Consequences
A Distributed Locus of Control: The Transformation of Medical Work
CHAPTER 6 · Producing Tools and Practices
Analysing the Lack of Success: Of Right Things and Right Places
Obstacles to the Tools: The Advocates' Analysis
Tools Which Cannot Work: The Critics' Analysis
The Production of Working Tools: Reanalyzing 'Success' and 'Failure'
Changes and Convergences
Different Questions, Different Issues
Of Maps and Terrains
Design as Critique
Producing Tools and Practices
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