Sensory Work of Diagnosis: A Crisis of Legitimacy

Sensory judgments have always been a part of medical practice, as sensory studies scholars have emphasized. However, in current regulatory, management and technological contexts, there is a push toward rational decision-making procedures and test-based evidence over clinical diagnosis. Sociological scholarship highlights that in focusing on explicit medical knowledge and disembodied data we take for granted aspects of healthcare work, including the ways in which health and illness is sensed. Research in sociologies of diagnosis and social studies of science and technology has captured that while the senses continue to play a role in medical work, the status and practice of this sensory work is not straightforward as evidenced by dual use of the senses and tests and the delegation of sensory work. Based on semi-structured interviews with expert doctors in diverse specialties, this article examines the sensory work of medical decision-making, with attention to its legitimacy. It examines applications of the senses from auscultation to ongoing sensing of patients’ bodies unmediated and via technological outputs. While critical to clinical judgments, there is discomfort with this sensory work in light of medico-legal pressures. I argue that the sensory work of diagnosis is vital, to the extent that gaps in sensory information imply gaps in understanding.     

‘Lost in transition?’ – Newly educated social workers’ reflections on their first months in practice

Entering the work of world can involve significant challenges for the beginning practitioner. The transition process from university to work can play an important role in the emerging practitioner’s development as a social worker. The present longitudinal study follows 12 Swedish social work graduates from university and over their first four years in practice. The study provides an insight into how newly educated practitioners may experience the transition from university to the world of work and considers how they can be prepared and supported to meet the challenges of practice within contemporary work contexts. The students were first interviewed just prior to leaving university [see Tham &; Lynch (2014). Prepared for practice? Graduating social work students’ reflections on their education, competence and skills. Social Work Education, 33(6), 704–717]. This paper captures the reflections of these students after four months in practice. Feelings of unpreparedness, unorganised, or even ‘chaotic’ perceptions of the workplace and uncertainty about the future were emergent themes, particularly among new practitioners employed in social services. The findings illustrate the vulnerability of these new practitioners and the importance of workplace induction and the provision of adequate support in their new professional roles.     

Expert Systems

Summary

Expert systems are computer programs which embody the expertise of a human expert in order to consult and advise on a specific problem. It is now becoming feasible to apply expert systems technology to problems in the human services. This article describes what expert systems technology is and how it may be applied in human service practice. Finally, some of the promises and pitfalls of this new technology are addressed.     

司法鉴定质证程序问题研究

由于历史和现实的诸多因素,我国在司法鉴定质证程序方面的法规还远未达到规范化、法制化的要求,还存在着缺乏审前程序、对鉴定人出庭作证没有强制要求、对鉴定结论的质证流于形式等问题,可以说目前司法鉴定领域出现的众多问题及争议,与此有着直接的因果关系。因此,建立一套统一的、科学合理的司法鉴定质证程序规则势在必行。     

美国行政法的演化及其对我国行政法完善之启示

美国行政法历经近两百年的发展 ,从最初的传送带模式演变为专家知识模式 ,发展到近代的成本———利益分析 ,尽管每一次模式转变的背景、原理不同 ,但目的都是为行政权的行使寻求合理依据。我国行政法起步晚 ,结构体系、程序运作等诸多方面均存在不完善之处。通过对美国行政法演化过程的介绍分析 ,总结出行政法自身固有的民主、法治、分权、正当程度等一些普遍性准则 ,探讨其对我国行政法在转变传统观念、完善分权结构、加强司法审查和完善行政程序等方面可能提供的裨益     

Re-inscribing Gender in New Modes of Medical Expertise: The Investigator-Coordinator Relationship in the Clinical Trials Industry

This article analyses the ways in which research coordinators forge professional identities in the highly gendered organizational context of the clinic. Drawing upon qualitative research on the organization of the clinical trials industry (that is, the private sector, for profit auxiliary companies that support pharmaceutical drug studies), this article explores the relationships between predominantly male physician-investigators and female research coordinators and the constitution of medical expertise in pharmaceutical drug development. One finding is that coordinators actively seek to establish relationships with investigators that mirror traditional doctor-nurse relationships, in which the feminized role is subordinated and devalued. Another finding is that the coordinators do, in fact, have profound research expertise that is frequently greater than that of the investigators. The coordinators develop expertise on pharmaceutical products and diseases through their observations of the patterns that occur in patient-participants' responses to investigational drugs. The article argues, however, that the nature of the relationships between coordinators and investigators renders invisible the coordinators' expertise. In this context, gender acts as a persistent social structure shaping both coordinators' and investigators' perceptions of who can be recognized as having authority and power in the workplace.     

Social inclusion in research: reflecting on a research project involving young mothers in care

This article considers social inclusion in research by reflecting upon a project involving young mothers in care, which used grounded theory methodology (GTM) to theorise their situations and emphasise their voice, a key issue in inclusion, and yielded mixed outcomes. GTM dealt poorly with inclusivity and was supplemented by a feminist orientation. This also failed young mothers. They were included by sitting on an Advisory Com-mittee, being paid an honorarium and assisting in disseminating results. These efforts were unable to overturn power dynamics that privileged researchers' ownership of the findings, and enabled them to benefit from doing research and their rela-tionship with funders. The attempt to change policies and practices that served clients badly was thwarted by an election that brought in a régime with different goals. The young women authored their own stories and spoke authoritatively of their experiences. However, inclusion was not fully secured in and by the research process. Their positioning as research subjects curtailed their potential in this regard.     

21世纪体育教师的素质结构

采用文献资料法 ,本文从多维角度阐明了在提倡素质教育的今天 ,作为一名体育教师所必须具备的素质结构。体育教师不仅要进一步提高和完善自我的思想品德素质、业务素质和教学能力素质等几方面的修养。而且在教学中要勇于开拓、敢于创新、进行科学研究 ,为新世纪培养更多的合格人才。     

论“有专门知识的人”参与刑事诉讼——兼论《刑事诉讼法》第192条

"有专门知识的人"参与刑事诉讼的制度具有保障当事人对鉴定意见的质证权、辅助法官对是否采信鉴定意见作出判断、使重新鉴定申请和决定依据更加充分等功能和价值。其积极作用的奏效,亟待解决如下理论问题:"有专门知识的人"的诉讼地位、中立性、意见效力、选任资格及启动程序等。"有专门知识的人"应界定为"专家辅助人",属于广义的诉讼参与人。他们具有倾向性的问题,要完善启动和选任程序,确保其客观公正地提出意见。可由各省高院牵头成立"专家库",由法庭根据控辩要求从中择优聘请。"有专门知识的人"出庭的费用由司法经费出资以确保其立场中立。