Postphenomenology: A Critical Companion to Ihde

17. Technological Mediation and Embodied Health-Care Practices

231 17 Technological Mediation and Embodied Health-Care Practices Finn Olesen Introduction Don Ihde’s far-reaching philosophy of technology, particularly his account of technical mediation, provides a useful framework for addressing questions concerning how research on high-tech solutions in the health-care services can be linked with philosophical ideas about human nature, knowledge, and experience. Whereas earlier philosophies of technology have inquired abstractly into technological conditions, Ihde’s philosophy is concerned with what a particular technology does in a specific setting, and how subjects and artifacts constitute each other in praxis. The prominent efforts being made today in Denmark (and elsewhere) to establish nationwide, standardized computer solutions to efficiency problems in health-care systems, will advance a move away from clinical knowledge— based on situated knowledge and embodied practical experiences—toward increased scholastic knowledge—based on explicit knowledge and rule-based actions. This kind of move will involve altered environments for interactions between health professionals and for their communication with patients, and it will imply both premeditated and unexpected transformations of particular work tasks in the health domains involved. Thus, the effective range of “doable ” problems for the health professionals will be altered in a number of ways that goes beyond rational planning. These changes pose questions for how to study such altered conditions and their alleged consequences. On what level of observation should such alterations be studied? What theoretical framework is able to grasp the magnitude of the issue? As stated above, Ihde’s philosophy of technology offers a beneficial set of tools and methods to investigate these questions. 232 Finn Olesen Health Care and Digital Efficiency The Public Health Services in Denmark face a number of challenges these years, mostly a result of political determination to improve the effectiveness of the domain with the help of computer-based information technology (IT). At present the magnitude of these challenges is arguably most visible in the various attempts to develop and implement a nationwide Electronic Patient Record (EPR). The overall goal of that undertaking is to make basic functions and activities in the national health services more rational. They are to be made more efficient and economical in order to improve the treatments of patients and upgrade the organization of health-care work. For these ambitions to be fulfilled, a shared set of standards is required. They are of different kinds: There need to be interchangeable standards for database structure, search hierarchies, programming languages, and hardware capacity. These standards are all, predominately, of a highly formalized kind. Furthermore, there needs to be a unifying focus on professional language and terminology, for instance on classification and definition of key words, and how to structure communication processes. This is all about semantic standards, and the National Board of Health has already introduced a set of semantic standards to be used by all parties in the national quest. Moreover, job performance will have to be coordinated by the various groups of health professionals, both internally in particular wards, and externally in accordance with outside groups and domains. It appears to be generally recognized among the central players that, without tending to all levels of the standardization work, it is highly unlikely that Denmark will gain computer-supported health services on a national scale and the consequent improvement in efficiency. Crucial to the further spread of IT as an instrument of standardization is the expression of professional language and work processes in the health sector in unambiguous, clear definitions and concepts. During the last decade this kind of standardization work has increased on both national and on organizational levels. Such politically and economically motivated visions of IT-based solutions to improve the efficiency of work and communication in the health-care system are strongly influenced by certain culturally inherited presumptions regarding relationships between technology and humans. One such predominant assumption that seems rather hard-lived, concerns the alleged neutrality of technological artifacts. It is those who use technology who are to blame or praise for technology-related changes, not the artifact or system itself. Ihde, among others, has rejected this view and demonstrated its shortcomings . He has made the case for postphenomenology as a separate perspective , from where it is meaningful to claim that humans and technology coconstitute each other (PP). Hence, both humans and artifacts are shaped by Technological Mediation and Embodied Health-Care Practices 233 the labor...