Rationalizing Medical Work
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.
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.
“Is medicine a science or an art? Marc Berg's contribution to thislong-standing debate moves away from normative arguments replacing themwith an ethnographic inquiry that goes to the heart of medical work. Berg'sanalysis leads to a provocative new understanding of the practice ofmedicine and of medical judgment, grounded in a detailed empirical accountrather 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 electric 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
“Berg’s superbly well-written book makes a brilliant contribution to work in both information systems design and the sociology of science and technology. He has combined a deep understanding of medical information systems with a clear sociological gaze to produce a book which should be read by anyone interested in how information systems work. The tension between local and global is core to our times: this work provides us all with some fresh tools to think with.”
—Geoffrey C. Bowker, Associate Professor, Graduate School of Library and Information Science, University of Illinois at Urbana-Champaign