Opening up the black boxes of our primary care systems

[摘要] This issue focuses on primary care systems, and the selection of articles in Life & Times celebrates the often overlooked details of what happens within them, what influences them, and what wider influence they might have.Primary care systems can clearly be described as networks of people and things, ideas, processes, relationships, and technologies. Where do we start? Social scientists often use a social theory as a lens or filter for seeing through the chaotic fog of everything happening at once. Actor network theory (ANT), for example, has been handily summarised by Greenhalgh and Stones (2010), in their discussions of big information technology programmes in health care.ANT considers networks made up of both people and technologies. ANT focuses on what people and things become as a result of their position in a network and the dynamic configurations of human and non-human actors. Actor-networks are often highly dynamic and inherently unstable. They can stabilise to some extent when people, technologies, roles, routines, training, incentives, and so on are aligned. This alignment is attempted in four stages: problematisation (defining a problem for which a particular technology is a solution), interessement (getting others to accept this problem-solution), enrolment (defining the key roles and practices in the network), and mobilisation (engaging others in fulfilling the roles, undertaking the practices, and linking with others in the network).Stability of an actor-network is an unacknowledged truce, achieved through ‘black boxes’ — configurations of actors (human and non-human) that have become taken-for-granted as the way things are, and hence are no longer questioned. The general format of a research question from an ANT perspective — ‘What is the network, and what phenomena are emerging from it?’ — might readily be applied to primary care systems. The tricky question here is whether we consider primary care systems to be networks or the solution to a problem within a network.THE GHOSTS IN THE MACHINE Our reviews this month reflect the relevance of seeing and understanding the ecosystem we inhabit and its constituent elements, including us! I review a beginners’ guide to economics and find that many of the ideas describe the trials and tribulations of practitioners and patients.Trish Greenhalgh reflects on an edited collection that showcases application of ‘mindlines’ in medical practice. These are the strains, interests, concerns, and relationships that are the stuff of interessement and mobilisation. Ben Hoban reviews the work of Dilys Daws and learns how to be quietly disruptive: this can mean resisting the pressure to ‘do’, and listen instead. David Misselbrook, meanwhile, finds that a new paediatric text is a source for shared understanding between generalists and specialists — surely a recipe for a healthy primary and secondary care interface.

[学科分类] 卫生学