Rationalizing Medical Work: Decision-support Techniques and Medical Practices

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"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."
-- 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 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 workinto 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.

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"

 

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Contents

Reconceptualizing Postwar
11
The Different Voices of DecisionSupport Techniques
71
The Localization of a Tool
103
5
123
Producing Tools and Practices
155
Notes
179
References
205
Index
235
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