Systems Theory and the Sociology of Health and Illness by Morten Knudsen Werner Vogd

Author:Morten Knudsen, Werner Vogd [Morten Knudsen, Werner Vogd]
Language: eng
Format: epub
ISBN: 9781138503403
Barnesnoble:
Publisher: Taylor & Francis
Published: 2017-06-29T00:00:00+00:00

The admission of Herr Spondel presented here gives an idea of how these processes can be shaped as contradictory units. The ward physician used the term ‘MCA’ to refer to the intervention by the external nephrologist into hospital routines which allowed a treatment process that would not otherwise have been possible under the economic logic of the hospitals themselves but that then, by means of a successful ‘control test’ of the network partner, was able to pave the way for the medical logic of action.15

In Luhmann’s terminology, the interaction via the treatment network circumvents the organisation to the benefits of the medicine. To quote Teubner once more, ‘[h]ybrid networks, in this case, appear as manna from heaven, being exactly tailored to bridge multiple contradictory rationalities. They facilitate mutual interference between rationalities without the imposition of hierarchical order’ (Teubner 2006: 21).

Regarding a class of observations characterised by the fact that ward doctors consult with other hospitals, care institutions and general practitioners about further proceedings for their patients, this indicates a possible feature of future treatment processes. In treatment networks, the social skills of the doctors were then no longer limited to coping with the situation within the meeting space of their organisation. It would no longer be sufficient to develop a practical feeling for relevances, power struggles and knowledge structures in their organisation. The challenge will be to function in networks, that is, to cope with external control attempts and conversely to exercise control on the partners in the network. The same now also applies for patients and their relatives, who can no longer rely on certainties (also these were only in the form of reliable hierarchical relationships) but must see themselves as an active component of the treatment network and the associated negotiation processes. The uncoupling is now not only (as described by the neo-institutionalists) between the individual spheres within an organisation but takes place in a distributed network of autonomous organisations, with the DRG technology playing a key role in brokering these processes. DRGs represent in this sense ‘leaky black boxes’ or ‘knowledge objects’ (Lowe 2001) around which the networks organise themselves.

In view of the accelerated processes, medical expertise will become even more important under the future conditions, and this is succinctly expressed in the chief physician’s statement on medical elegance already documented: ‘Do not make things complicated, but think complexly.’ This leads to increasing mutual demands between the partners in the treatment network concerning the processing of complexity, the reflection of medicine and resource deployment. in the medium term, this could lead to the economic paradoxical situation that a more economically driven medicine will only come at the price of more expensive expertise.

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