Reconfigured Medication: Writing Medicine in a Sociotechnical Practice

Put in general terms, we aim to show in this paper that it is complicated to simplify a sociotechnical practice. Humans, things, symbolic exchanges, and spatiotemporal coordinations have to be reconfigured in numerous ways before the simplifying procedure appears to be the cause of a new kind of stability. Hence, stability is the result of dynamic processes, and it depends on the participating actors how (well) the simplifying procedure is actualized and for how long it remains stable. Accordingly, simplification is not seen as the cause of a better practice; rather, it is an effect of numerous transformations of existing and new procedures and activities.²

The reason we often see simplification as a desirable goal has to do with certain culturally inherited knowledge ideals, whereby Euclid's geometrical economy and Descartes's algebraic representations (among other examples) stand out as ideal models of how to improve our understanding of the world. In science, for instance, the simpler hypothesis will be preferred to the complex when guided by this ideal.³ But simplicity is primarily that: a metaphysical ideal stemming from abstract, a priori categories; and proponents of the ideal of simplicity may easily make the mistake of thinking that abstract categories can be gracefully applied in practical life settings.⁴ Mathematical demonstrative power is generally ill-suited to depicting the heterogeneous relations and processes of non-ideal life situations.

While mathematics is concerned with detached universals, we will argue for the advantage of studying situated particularities—that is, the materially located settings in which simplifications are tried out, and where reconfigurations happen in practice. We support this stand through an account of some empirical findings we gathered in the fall of 2000 in a plastic surgery ward at a large Danish hospital. Through a number of visits we studied the successful incorporation of an electronic medication module (EMM) into daily work routines on the ward. Our field study was centered on how medicine, staff, and writing were translated and transformed in order for the EMM to become a stable part of the ward's work routines.⁵ The module is part of an electronic patient record already used by various professionals, both individuals and groups, in the ward. From the start its purpose has been to simplify a number of basic procedures related to medication. By applying the EMM, it is only the doctor who is allowed to write down the prescribed medicine. Before, a specific medication for a patient might be copied onto four or five forms and charts by various health professionals, entailing a persistent risk of faulty reading and misadministering.⁶

There are two related objectives of this paper. First of all, we wish to encourage a culturally grounded approach to studying the implementation of advanced technology in a community of interacting professionals. By stressing the term "culture" we mean to say that our approach is committed to the material and symbolic doings of actors in everyday life settings. Hence, to us, culture is what people and things do, including the symbolic meanings attached to those actions by the practitioners. In what follows we want to demonstrate that the successful incorporation of the EMM in the hospital ward can be seen as an effect of numerous visible and invisible work processes entailing many reconfigurations of humans, things, and meanings.

The approach is partly inspired by anthropological studies such as those by Lucy Suchman, Julian Orr, and Diana Forsythe, who have all done ethnographic field work to learn how professionals like copy-machine technicians, or artificial intelligence researchers, deal with machines in concrete work situations.⁷ Closely related to this approach is the suggestion from the sociologist and founder of symbolic interactionism Anselm Strauss that one should study articulation work. One of his former students, Susan Leigh Star, has defined this: "Articulation work is work that gets things back 'on track' in the face of the unexpected, and modifies action to accommodate unanticipated contingencies. The important thing about articulation work is that it is invisible to rationalized models of work."⁸ The quotation stresses the...