Rationalizing medical work1997

Our response to the skyrocketing cost and nonuniform delivery of medical care 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 they will make medical practice more rational, more uniform, and more efficient and that they will transform the "art" of medical work into a "science." Critics 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 they transform medical practices and discusses what is gained and what is lost. Berg investigates how new discourses on medical work and its problems are linked to the development of decision-support tools. Studying the construction of several individual technologies, he looks at what medical work consists of and how the new technologies figure in and transform it. Although he focuses on decision-support techniques in the field of medicine, the issues he raises are relevant wherever rationalizing techniques are being debated or constructed. Touching upon broader issues of standardization, universality, localization, and the politics of technology, Berg addresses problems that are central to medical sociology, technology studies, and tool design.