Between a logic of disruption and a logic of continuation: Negotiating the legitimacy of algorithms used in automated clinical decision-making

Torenholt, R (通讯作者),Univ Copenhagen, Oster Farimagsgade 5, DK-1014 Copenhagen K, Denmark.
2023-1
In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation: here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools - involving algorithmic sorting - in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians' expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems.
HEALTH
卷号:27|期号:1|页码:41-59
ISSN:1363-4593|收录类别:SSCI
语种
英语
来源机构
University of Copenhagen
资助机构
Danish Cancer Society(Danish Cancer Society)
资助信息
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Danish Cancer Society (Grant number R133-Rp12097).
被引频次(WOS)
2
被引频次(其他)
2
180天使用计数
0
2013以来使用计数
4
EISSN
1461-7196
出版年
2023-1
DOI
10.1177/1363459321996741
关键词
cancer and palliative care chronic illness and disability ethnography technology in healthcare theory
WOS学科分类
Public, Environmental & Occupational Health Social Sciences, Biomedical
学科领域
循证公共卫生 循证社会科学-综合