Tag: medical anthropology

Negotiating Ethical Technology Use: Trust and Care in End-of-Life Conversations

  The headline on the local news station’s website was sensational: “Bereaved Family Upset Kaiser Used Robot to Tell Father He Would Die”. Evoking some sort of post-modern dystopia, the article explains that the family “was taken by surprise when a robot rolled into the room” to deliver the news that an elder family member’s illness had progressed past the physician’s ability to treat it. While the robot actually was a remote physician using teleconferencing software to communicate with the patient and his family, the monitor projecting an image of the physician’s head and shoulders sat atop a tall, narrow metal unit reminiscent of a body. The “robot doctor” story was picked up by national news outlets, like the New York Times, and medical ethicists weighed in on the ethics of communicating “sensitive” topics remotely. The news stories problematized the impersonal, almost routinized, care as it was perceived by the family. In one, a representative from the American Medical Association commented, “We should all remember the power of touch – simple human contact – can communicate caring better than words.” (read more...)

Clinical Data in the U.S. Department of Veterans Affairs: Ethnographic Engagements

By: Peter Taber, Nicholas Rattray, Lauren Penney, Megan McCullough and Samantha Gottlieb This post emerged from a 2018 Society for Applied Anthropology panel on anthropological engagements with health data in the U.S. Department of Veterans Affairs (VA). Serving over 9 million enrollees with a current federal budget of USD68 billion, the VA is an important testing site for digital healthcare infrastructure, as it has been for several decades. The panel brought our VA research and quality improvement (QI) efforts targeting the electronic health record (EHR) and other digital infrastructure into dialog with existing work on the social lives of data and algorithms, as well as the broader concerns of medical anthropology and STS in an era of the “datafication of health” (Ruckenstein and Schüll 2017). Extracts from our conversation, presented below, are taken from a follow-up video call exploring these issues. (read more...)

Computable Norms: Clinical Practice Guidelines and Digital Infrastructure

I’m a sociocultural anthropologist by training. Until recently, my research focused on environmental issues in Ecuador. Yet, my attempt to address the gaps left by traditional anthropological approaches to environmental issues quickly brought me into topical areas that the anthropology I was trained in infrequently touched on: institutional change over historical time, knowledge infrastructure work, and particularly the functioning and interaction of modern forms of expertise. I’m now a postdoctoral fellow in medical informatics at the U.S. Veterans Affairs Administration.  It is an odd organizational context to find myself in, as someone who conceived of himself as an environmental anthropologist for years. Yet many of the big themes are strikingly familiar. In particular, I am surrounded by (and participating in) the expert design of sociotechnical contexts intended to be inhabited by other experts – an aspect of environmental expertise that fascinated me in my environmentally-focused research. In my postdoc, I’m fortunate to have exposure to many of the technical nuts and bolts of infrastructure design for clinicians. In my remarks below, I share some reflections about “clinical practice guidelines,” a specific form of formal medical guidance that increasingly constitutes part of the digital infrastructure used by medical providers, designed and implemented in part by informaticists. (read more...)

Weekly Round-up | April 28th, 2017

Thanks to input from a number of helpful readers (you know who you are), we’ve got a bunch of great posts for you this week, running from from evil infrastructure and essential books to Reddit and Duke Nukem. Keep ’em coming! (read more...)

Forsythe Prize Author Sharon Kaufman on Ordinary Medicine

I am delighted to be the recipient of the honorable mention, Diane Forsythe Prize for Ordinary Medicine: Extraordinary Treatments, Longer Lives and Where to Draw the Line (Duke University Press 2015). The book is an ethnography of the invisible social, economic, and bureaucratic forces that have made once extraordinary therapies seem ordinary and necessary. Medicine’s ability to prolong wanted life through both low-tech and high-tech interventions is a positive development in many respects. Yet the socio-medical imperative to employ death-defying techniques now exists in an ever-aging society in which private industry churns out greater numbers of interventions than ever before; in which no age or cost limits exist for insurance reimbursement of those procedures; in which many older persons, their families and their health providers must consider whether additional treatment will bring with it pain and suffering; and in which saying ‘no’ to new technologies seems somehow suspect or ethically wrong. These features of American society and health care organization have spurred our lively national conversation about whether staving off death is always the best thing to do. And, those features have created the quandary, experienced by millions, of where to draw the line between ‘enough’ and ‘too much’ treatment. (read more...)

The 2014 Ebola Outbreak: How Many Deaths Will it Take?

When I began writing this brief statement in mid-September, 2,630 deaths had been attributed to probable, suspected, or confirmed cases of Ebola. The World Health Organization projected as many as 20,000 cases in the West African region before the outbreak could be brought under control. The epidemic had received little news coverage and felt, to many in the U.S., as yet another disaster taking place in countries reputed for their many dangers. By mid-October, 4,033 Ebola deaths had been reported by the World Health Organization and projections on number of cases had risen to 10,000 per week in West Africa. Concerns are heightening that the epidemic may be a greater threat than originally perceived. The number of news reports providing coverage on the epidemic has increased exponentially, reaching over 30 million by the beginning of October. This dramatic increase appears to be spurred by the death of Thomas Eric Ducan, the first reported death occurring outside the epidemic hotspot of West Africa, which made headline news around the world and sparked fears that the epidemic could spread out-of-control around the globe. (read more...)