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Beyond Information: Intimate relations in clinical practice. Maggie Mort Institute for Health Research Centre for Science Studies Lancaster University UK. Acknowledgements. Carl May and Tracy Finch (University of Newcastle Upon Tyne) Frances Mair (Glasgow University)
Institute for Health Research
Centre for Science Studies
Lancaster University UK
(NHS Information Authority 2004)
(NHS Executive, Information for Health 1998)
…medical knowledge has moved beyond the clinic and is available ‘over the wire’…clinical decision-making is rooted not in the intellect of the practitioner, but within health ‘intelligence’…an information science.
(Nettleton, The Emergence of E-Scaped Medicine, Sociology, 2002)
(Jos De Mul, The Informatisation of the Worldview, Information, Communication & Society, 1999)
The assumption that the information will be accurate or complete enough to base emergency clinical judgments on seems unrealistic. A lot of GP computer data is excellent but much is incomplete and some inaccurate. You will be accessing data stripped of context and possibly free text, without knowing the reliability of the data recorder, no audit trail …and no idea how many times it has been mangled by data transfer.
E-Health Insider Readers Comments March 2005
Medicine: The science or practice of the diagnosis and treatment of illness and injury and the preservation of health
(OED, 2002, 5th Edn)
1. An instruction; 2. Communication of the knowledge of some fact or occurrence; 3. Knowledge or facts communicated about a particular subject, event; 4. Without necessary relation to a recipient: that which inheres in, or is represented by a particular arrangement, sequence or set, that may be stored in, transferred by, and responded to, by inanimate things.
(OED, 2002, 5th Edn).
The ECG tracing shows a run of different rhythms, then reverts back to normal. A1: Are you all right there? [to patient] A1 changes the bag of fluid. He touches something on the monitor and the screen changes. After a moment it goes back to normal. Pulse 92, oxygen saturation 98%.
(Observation 4: senior house officer, trauma list)
A2 is standing by the pump looking at the monitoring screen. He presses buttons on the pump, … totally isolated low BP (44 ⁄ ?) in the presence of a good radial pulse… artefact…
R: …I was going to ask whether you believed it…
A1 back to the anaesthetic machine [which is just taking another BP reading].
A2: See! He points to a blood pressure of 103 ⁄ .
(Observation 32: consultant anaesthetist, orthopaedic list)
Nurse01: The referral note there is free text, so I can write whatever I want. Whether or not they decide to read it at the end or skim through it or read it, I feel I can put everything I feel is necessary down. So if the questions on the history don’t fit, if there’s something in there I think it doesn’t fit in there, [such as] they may have already have been referred to the department ten years ago and had treatment, there’s nowhere to put that, but I can put it in the free text.
(Interview following teledermatology clinic)
(interview following teledermatology clinic)
action isn’t or can’t be accomplished by finding more and better ways of mobilising archival information.
(Heath C & Luff P, Technology in Action, 2000)
in anaesthesia and teledermatology we saw practitioners working intimately with machines
this intimacy comes about through the labour of ‘making things work’, enabling action, rather than proving every point explicitly in sequence.
Those who lack intimacy with the machine cannot be expected a priori to have insight into its limitations.
in practice – not that much