Working with protocols: a sociological view

This sociological study discusses three assumptions on the nature of medical work, which can be found in protocols. First, protocols assume that medical data exist as clear-cut, elementary bits of information. Second, they assume that medical criteria are well-defined and pre-set, fixed rules, which merely have to be applied. Finally, protocols depict medical work as a sequence of individual steps which each need to be terminated before the following can be made. Sociological studies of physicians at work, however, show that medical work is characterised by interactive, pragmatic reasoning, by fluid criteria, and by the (re)constructive nature of medical data. By discussing the three assumptions, this article demonstrates how medical personnel have to actively intervene to prevent the protocols' misalignment with the nature of medical work from creating problems. This does not mean that protocols are 'bad tools': the fact that it takes work to get a technology to function does not disqualify it. But this observation does imply that protocols cannot be regarded as tools which simply 'support' the work of physicians. Also, these observations shed an interesting light on the prevalent claim that protocols 'rationalise' medical work.