Rationalizing Medical Work: Decision Support Techniques and Medical Practices (Inside Technology) Review

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(More customer reviews)This was a book waiting to be written. Marc Berg discusses the turn to rationalization in medicine with exciting case-studies. The theoretical arguments are subtle and require a close reading but highly influential. Part of the intellectual off-spring of Bruno Latour and Donna Haraway. I use this book in my medical sociology and technology course.

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One response to the current crisis in medicine--indicated by largevariations in practice and skyrocketing costs--has been a call for the rationalizingof medical practice through decision-support techniques. These tools, which includeprotocols, 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 toolscannot and should not supplant humans in most real-life tasks.Marc Berg takes theissues raised by advocates and critics as points of departure for investigation,rather than as positions to choose from. Drawing on insights and methodologies fromscience and technology studies, he attempts to understand what "rationalizingmedical practices" means: what these tools do and how they work in concrete medicalpractices. Rather than take a stand for or against decision-support techniques, heshows how medical practices are transformed through these tools; this helps thereader to see what is gained and what is lost.The book investigates how newdiscourses on medical work and its problems are linked to the development of thesetools, and it studies the construction of several individual technologies. It looksat what medical work consists of and how these new technologies figure in andtransform the work. Although the book focuses on decision-support techniques in thefield of medicine, the issues raised are relevant wherever rationalizing techniquesare being debated or constructed. Touching upon broader issues of standardization,universality, localization, and the politics of technology, the book addresses coreproblems in medical sociology, technology studies, and tool design.

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