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Technogovernance: evidence, subjectivity, and the clinical encounter in primary care medicine

Technogovernance: evidence, subjectivity, and the clinical encounter in primary care medicine
Technogovernance: evidence, subjectivity, and the clinical encounter in primary care medicine
Technological solutions to problems of knowledge and practice in health care are routinely advocated. This paper explores the ways that new systems of practice are being deployed as intermediaries in interactions between clinicians and their patients. Central to this analysis is the apparent conflict between two important ways of organizing ideas about practice in primary care. First, a shift away from the medical objectification of the patient, towards patient-centred clinical practice in which patients’ heterogeneous experiences and narratives of ill-health are qualitatively engaged and enrolled in decisions about the management of illness trajectories. Second the mobilization of evidence about large populations of experimental subjects revealed through an impetus towards evidence-based medicine, in which quantitative knowledge is engaged and enrolled to guide the management of illness, and is mediated through clinical guidelines. The tension between these two ways of organizing ideas about clinical practice is a strong one, but both impulses are embodied in new ‘technological’ solutions to the management of heterogeneity in the clinical encounter. Technological solutions themselves, we argue, embody and enact these tensions, but may also be opening up a new array of practices—technogovernance—in which the heterogeneous narratives of the patient-centred encounter can be resituated and guided
technogovernance, primary care, medical knowledge, united kingdom
0277-9536
1022-1030
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Rapley, Tim
eb4364d5-c016-403a-969a-aae1fd35a97c
Moreira, Tiago
974bd87b-c6fa-42b9-955c-42fab332113d
Finch, Tracy
b1916307-8516-4b70-8ba5-05d3310839de
Heaven, Ben
c1450e21-13bc-467f-98b4-6c6f233139c1
May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Rapley, Tim
eb4364d5-c016-403a-969a-aae1fd35a97c
Moreira, Tiago
974bd87b-c6fa-42b9-955c-42fab332113d
Finch, Tracy
b1916307-8516-4b70-8ba5-05d3310839de
Heaven, Ben
c1450e21-13bc-467f-98b4-6c6f233139c1

May, Carl, Rapley, Tim, Moreira, Tiago, Finch, Tracy and Heaven, Ben (2006) Technogovernance: evidence, subjectivity, and the clinical encounter in primary care medicine. Social Science & Medicine, 62 (4), 1022-1030. (doi:10.1016/j.socscimed.2005.07.003).

Record type: Article

Abstract

Technological solutions to problems of knowledge and practice in health care are routinely advocated. This paper explores the ways that new systems of practice are being deployed as intermediaries in interactions between clinicians and their patients. Central to this analysis is the apparent conflict between two important ways of organizing ideas about practice in primary care. First, a shift away from the medical objectification of the patient, towards patient-centred clinical practice in which patients’ heterogeneous experiences and narratives of ill-health are qualitatively engaged and enrolled in decisions about the management of illness trajectories. Second the mobilization of evidence about large populations of experimental subjects revealed through an impetus towards evidence-based medicine, in which quantitative knowledge is engaged and enrolled to guide the management of illness, and is mediated through clinical guidelines. The tension between these two ways of organizing ideas about clinical practice is a strong one, but both impulses are embodied in new ‘technological’ solutions to the management of heterogeneity in the clinical encounter. Technological solutions themselves, we argue, embody and enact these tensions, but may also be opening up a new array of practices—technogovernance—in which the heterogeneous narratives of the patient-centred encounter can be resituated and guided

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More information

Published date: February 2006
Keywords: technogovernance, primary care, medical knowledge, united kingdom

Identifiers

Local EPrints ID: 163695
URI: http://eprints.soton.ac.uk/id/eprint/163695
ISSN: 0277-9536
PURE UUID: add26eac-d51a-45e0-895b-bba9ee243ffb
ORCID for Carl May: ORCID iD orcid.org/0000-0002-0451-2690

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Date deposited: 10 Sep 2010 11:02
Last modified: 14 Mar 2024 02:06

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Contributors

Author: Carl May ORCID iD
Author: Tim Rapley
Author: Tiago Moreira
Author: Tracy Finch
Author: Ben Heaven

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