Thursday, October 24, 2019

Questions about medical records coming out of reading of Focuault


The Patient Question: [When does the subject who goes to the hospital to be cured change?  Who is going to hospitals?  When and why?  What kind of persons do we have on hospital beds?  When are they 'patients'?]

Subject of Medicine Question:  [When does the subject begin to be defined by these medical records?  When are persons, and not just patients, medicalized?  Relatedly, when do medical records become privileged?]

Medical Records Questions:  [When do medical records begin to be preserved within hospitals? Standardized to an extent so they can be distributed between different hospitals?  Summarizable so they can be extended to other domains/practices (i.e., medical records used in education, in criminal court, in insurance contracts, in epidemeology)?  These other domains/practices might be a possible entry in.]

Technical function of medical records technology:  [Who is compiling the medical records?  Nurses?  Medical secretaries?  What is their knowledge, role, and technological function?  Training manuals as a possible entry in.]

 Framing Question: What literature should our analysis be framed through?  Who is our audience?  What disciplines and/or journals do we want to speak to?


One possible hunch (but just a hunch at this point): [If the medicalization of the hospital was an effect/strategy (?) of 18th c. disciplinary power, then the medicalization of the person-become-patient was an effect/strategy (?) of 20th c. infopolitical documentation.]

Thursday, October 17, 2019

"The Incorporation of the Hospital into Modern Technology...." (3rd lecture)



3rd lecture: “The Incorporation of the Hospital into Modern Technology”


The medicalized hospital dates from the end of the eighteenth century
·         Exemplar of the investigations of/into hospitals in 1760s, which had three characteristics:
o   Reform and reconstruction
o   Transformation from monumental to functional description of hospitals, as well as a description of “the state of cleanliness”
o   Inquiries conducted by doctors, not architects
§  Hospital as a mechanism of cure is the effect/result of these inquiries
·         MF poses a hypothetical objection: the perennial hypothesis that hospitals have always been dedicated to curing (cf. to the perennial hypothesis about the prison in D&P)
·         MF will “express a series of objections to that hypothesis”
o   MF argues for a crucial distinction between medicine and hospital (cf. to the punishment and prison distinction in D&P)
Prior to the 18th c.:
·         Hospital was a place to gather and assist to the poor, and was an institution of exclusion
·         Medicine was an individualistic enterprise: individuals (rather than diseases) were cured
·         Medical intervention revolved around a concept of crisis
·         There was nothing in the medical practice that organized knowledge
How did the hospital become medicalized in the 18th c.?  (The causal question of why.) (144)
·         The “principal factor” was “annulment of the negative effects of the hospital” [??? this is perhaps an odd category of analysis for MF to be using]
o   An effect of purifying the hospital of its harmful effects and disorder
·         Reform began in maritime and military hospitals in the 17th century (145)
o   Economic vector
o   Quarantine vector
o   Maritime and military hospitals became a model
How did this reorganization come to be carried about?  (The technical question of how.) (146)
·         Short answer: discipline (as a “political technology”)
o   Not invented but elaborated [not origin but emergence]
o   Not isolated but “perfected” [by which he must mean not isolated but diffuse]
What is it that arises in this period?  [I.e., what is discipline?  An archaeological description] (146)
·         Characteristics:
o   A fourfold list of characteristics:
§  “An art of spatial distributions” – above all, an analysis of space
§  Control over not “the results of an action but on its development”
§  A constant and perpetual surveillance
§  Continuous registration
o   Contrast the fourfold list of discipline in D&P (which is maybe not a problem b/c it’s a different field of inquiry):
§  Art of distributions
§  Control of activity
§  Organization of time
§  Composition of forces
·         Basic instrument:
o   The examination [MF doesn’t say much about it here]

MF’s central claim: introduction of disciplinary mechanisms + displacing of medical intervention allowed its medicalization (148)
·         Displacement of intervention:
o   From crisis in health to intervention in environment
·         Introduction of disciplinary mechanisms
o   As described above.

Now we can understand several characteristics of the hospital (149)
·         Localization of hospital and internal distribution of space
·         Transformation of system of power in the heart of the hospital
·         Permanent and complete records that register whatever occurs; “a collection of documents”
o   [But how diffuse is this?]

All of this leads to the formation of the clinic as a site for the organization and transmission of medical knowledge (151)