Rationalizing Medical Work - 9780262024174

One response to the current crisis in medicine--indicated by large variations inpractice and skyrocketing costs--has been a call for the rationalizing of medical practice throughdecision-support techniques. These tools, which include protocols, decision analysis, and expertsystems, have generated much debate. Advocates argue that the tools will make medical practice morerational, 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 thefeasibility and desirability of the tools. They argue that formal tools cannot and should notsupplant humans in most real-life tasks.Marc Berg takes the issues raised by advocates and criticsas points of departure for investigation, rather than as positions to choose from. Drawing oninsights 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 medicalpractices. Rather than take a stand for or against decision-support techniques, he shows how medicalpractices are transformed through these tools; this helps the reader to see what is gained and whatis lost.The book investigates how new discourses on medical work and its problems are linked to thedevelopment of these tools, and it studies the construction of several individual technologies. Itlooks at what medical work consists of and how these new technologies figure in and transform thework. Although the book focuses on decision-support techniques in the field of medicine, the issuesraised are relevant wherever rationalizing techniques are being debated or constructed. Touchingupon broader issues of standardization, universality, localization, and the politics of technology,the book addresses core problems in medical sociology, technology studies, and tooldesign.