Knowing and acting in medical practice: the epistemological politics of outcomes research.
Recent health care policymaking favors outcomes research as a response to the putative ineffectiveness, as well as the undeniable expense, of American medicine. This small-scale ethnographic study conducted in a department of internal medicine evaluates claims that probabilistic knowledge will improve clinical practice. It finds that physicians are primarily determinists and that although they reason probabilistically in some instances, they rely on personal experience over research data at these times; that doctors view outcomes research as useful but not definitive and in no way immune to the social influences on medical knowledge generally; and that their mix of determinism and probabilism is well suited to the nature of medical work. The recent ascendancy of outcomes research is as much political as scientific, empowering the research community relative to practicing physicians, lending medical legitimacy to payer-promulgated practice guidelines, and creating additional clinical work around a false standard of medical certainty.
Tanenbaum
S J
SJ
Ohio State University.
D001291:Attitude of Health Personnel; D002986:Clinical Trials as Topic; D005260:Female; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D017063:Outcome Assessment, Health Care; D010820:Physicians; D011057:Politics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011336:Probability; D011640:Public Policy; D012107:Research Design; D014481:United States; D016270:United States Agency for Healthcare Research and Quality