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When protocols fail: technical evaluation, biomedical knowledge, and the social production of 'facts' about a telemedicine clinic

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  • May, Carl
  • Ellis, Nicola T.

Abstract

Telecommunications systems seem to offer health care providers, professionals and patients a plethora of opportunities to respond to social and geographical inequalities in health care provision, and a new field of health care endeavor has emerged -- 'telemedicine'. This paper presents results from a three year ethnographic study of the development and implementation of telemedicine systems in a British region. We explore how attempts to put into service one 'telemedicine' system failed to get beyond the draft of a written protocol. Our analysis focuses on the contests between clinicians, technical experts and external evaluators over what kinds of knowledge and practice count in developing a protocol and evaluating a clinical intervention. We show how the introduction and implementation of 'hard' technologies (systems hardware) can be undermined in practice by 'soft' technologies (the practices through which evaluative knowledge is produced).

Suggested Citation

  • May, Carl & Ellis, Nicola T., 2001. "When protocols fail: technical evaluation, biomedical knowledge, and the social production of 'facts' about a telemedicine clinic," Social Science & Medicine, Elsevier, vol. 53(8), pages 989-1002, October.
    • Handle: RePEc:eee:socmed:v:53:y:2001:i:8:p:989-1002
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    Citations

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    Cited by:

    1. Hedgecoe, Adam, 2005. "'At the point at which you can do something about it, then it becomes more relevant': Informed consent in the pharmacogenetic clinic," Social Science & Medicine, Elsevier, vol. 61(6), pages 1201-1210, September.
    2. Gibson, Mark & Neil Jenkings, K. & Wilson, Rob & Purves, Ian, 2006. "Verbal prescribing in general practice consultations," Social Science & Medicine, Elsevier, vol. 63(6), pages 1684-1698, September.
    3. Nicolini, Davide, 2006. "The work to make telemedicine work: A social and articulative view," Social Science & Medicine, Elsevier, vol. 62(11), pages 2754-2767, June.
    4. Kate Lyle, 2021. "Interventional STS: A Framework for Developing Workable Technologies," Sociological Research Online, , vol. 26(2), pages 410-426, June.
    5. May, Carl & Finch, Tracy & Mair, Frances & Mort, Maggie, 2005. "Towards a wireless patient: Chronic illness, scarce care and technological innovation in the United Kingdom," Social Science & Medicine, Elsevier, vol. 61(7), pages 1485-1494, October.
    6. Williams, Tracy & May, Carl & Mair, Frances & Mort, Maggie & Gask, Linda, 2003. "Normative models of health technology assessment and the social production of evidence about telehealth care," Health Policy, Elsevier, vol. 64(1), pages 39-54, April.
    7. Massazza, Alessandro & May, Carl R. & Roberts, Bayard & Tol, Wietse A. & Bogdanov, Sergiy & Nadkarni, Abhijit & Fuhr, Daniela C., 2022. "Process evaluations of mental health and psychosocial support interventions for populations affected by humanitarian crises," Social Science & Medicine, Elsevier, vol. 303(C).

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