Looking for Trouble: Medical Science and Clinical Practice in the Historiography of Modern Medicine

In recent years, many editorials in leading North American medical journals have argued that medical practice is seriously flawed. Ofter, decision-support techniques are mentioned as a potential solution to this problem. I argue that these recent calls embody a specific reconceptualization of medical practice and its problems. Within the postwar medical literature, divergent discourses on the virtues and troubles of postwar medical practice can be found. Through a focus on medical editorials, I demonstrate the existence of several different notions of the 'scientific nature' of medical action. Comparing the more recent of these images to those dominating earlier medical journals, one main shift is apparent. While, earlier, medical action was often described as an artful application of scientific knowledge, only mildly tainted by external, social problems, recent conceptualizations often locate both the scientific nature of medicine and the causes of its problems in the physician's brain. Even within this new discourse, however, scientific rationality does not always speak with the same voice, as reflected in the existence of different decision-support techniques. I argue that these different techniques, which are presented as solutions to the flaws of medical practice, lay at the root of the development of the cognitivist image(s) in the first place. Show more