School of Health and Human Sciences, University of Essex.
Sociol Health Illn. 2013 Jun;35(5):731-45. doi: 10.1111/j.1467-9566.2012.01524.x. Epub 2012 Sep 26.
The practice of medicine is often represented as a dualism: is medicine a 'science' or an 'art'? This dualism has been long-lasting, with evident appeal for the medical profession. It also appears to have been rhetorically powerful, for example in enabling clinicians to resist the encroachment of 'scientific' evidence-based medicine into core areas of medical work such as individual clinical judgement. In this article I want to make the case for a more valid conceptualisation of medical practice: that it is a 'craft' activity. The case I make is founded on a theoretical synthesis of the concept of craft, combined with an analysis of ethnographic observations of routine medical practice in intensive care. For this context the craft aspects of medical work can be seen in how biomedical and other types of knowledge are used in practice, the embodied skills and practical judgement of practitioners and the technological and material environment. These aspects are brought together in two conceptual dimensions for 'craft': first, the application of knowledge; second, interaction with the material world. Some practical and political implications of a 'craft' metaphor for medical practice are noted.
医学是一门“科学”还是一门“艺术”？这种二元论由来已久，对医学界具有明显的吸引力。它似乎也具有很强的修辞力量，例如，它使临床医生能够抵制“科学”循证医学对医学工作核心领域（如个体临床判断）的侵蚀。在本文中，我想提出一种更有效的医学实践概念化方法：即它是一种“技艺”活动。我提出的观点是基于对技艺概念的理论综合，结合对重症监护常规医学实践的民族志观察的分析。在这种情况下，可以看到医学工作的技艺方面，包括生物医学和其他类型的知识在实践中的应用、从业者的体现技能和实际判断以及技术和物质环境。这两个方面在“技艺”的两个概念维度中结合在一起：一是知识的应用；二是与物质世界的互动。注意到“技艺”隐喻对医学实践的一些实际和政治影响。
