Rationalizing medical work

by Marc Berg

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 transfor