Hello everyone. My name is Alena. Today, I'll give you lecture on standardized healthcare practices. So, in the previous lecture, we were talking about the process of professionalization in medicine. Let's now move to the content of medical work and trace the history of standardization of medical practice. The standardization in medicine can be described as a process of re-negotiations of communication practices between medical scientists, medical practitioners, and patients. So, the process of standardization divides medical practice into the areas of expertise. But the process of treatment is transforming from the form of art performed by one practitioner expert into a standardized algorithm of actions conducted by independent experts, groups of experts, or et cetera. So, in today's lecture, we will focus on the conceptual changes that took place in healthcare practice, started from the end of the 18th century, that led to the disjunctures that will be discussed during this course that we have. So, before the development of clinical method, where physician determines causes and symptoms of illness, a disease was understood as something separate and extrinsic to humans. Practitioners were often applying the process of trial and error to decide what treatment is the best for a particular disease. So this is the outline of our lecture, what we will discuss today. But going to the medicine as a form of art, for instance in a slide, you can see the picture of James Lind. He was a British Navy Physician and he was trying to treat scurvy among sailors. He tried different kinds of treatment in order to understand how to combat this disease. So, to find the best treatment, Lind prescribed to sailors different possible alternatives, such as, for example, two oranges and one lemon, or a half pint of seawater, or six spoon of vinegar for different groups of sailors, and et cetera. So, at that time, the process of treatment was a form of art, where doctors had the power to try and experiment with different techniques to eliminate the disease. All of patients and wider society recognized them as experts who possess authority. For doctors who performed the treatment, a disease appeared to be no less of a black box than it was for patients. A disease was not a result of signs and symptoms of have to be analyzed, but it was something singular that is happening in the current moment and doesn't have a history. So, at that period, a disease was a kind of a black box that was closed for both doctors and patients, and doctors took a role of kind of artists who were trying to unlock this black box in order to understand how to treat this disease. The major shift in the development of medical practice and medical standardization happened in the 19th century. That time, as philosopher Michel Foucault, you could see him here, he described that tremendous shift by saying that doctors finally opened the corpse and they located the disease within a patient body. Before that moment, a patient and a disease were related to each other only extrinsically. A disease manifested itself through the body of patients. After the corpse was opened, it was no longer the case. Disease became not just statistically absorbable bunch of science and characteristic disseminated through the body of a patient, but it is a bundle of symptoms and deformations that can be found in patient's body and can befall step-by-step. So, in the 19th century, it was the body of the patient itself that become ill, and that was a huge step forward in the medicine and also medical standardization. So, after a disease was located within a body of a patient, anatomic pathology came into place, and doctors started to associate and correlate different kinds of signs and symptoms with a particular organ and a place in the body of a patient. That was the point the medical observation become a routine of medical treatment. Therefore, medical investigation came into place. Doctors now can make diagnosis and assign a therapy. So, they first need to understand which organ or part of the body is affected by the disease after they make the diagnosis and prescribe treatment. Anatomic pathology gave doctors a chance for comparison and investigation. They now can establish not only causes and symptoms of different diseases, but they can also investigate how bodies react on different treatments of procedures. So, a lot of doctor researcher became an important component of healthcare, and it started to transform medicine from a form of art into a science because doctors now can try which treatment is the best for a particular disease, but already having knowledge from other sciences as well. So, in the 20th century, doctors researchers already knew causes and symptoms of different diseases. They knew how the symptoms are spread and how to treat particular diseases and what treatment and medicine have to be prescribed. However, if you look at Annual Urban Clinic, for example, in the US in the 20th century, we will see that treatment varied from patient to patient. Two patients who has exactly the same symptoms may received very different treatment. Some patients may have been taken, for example, blood and urine analysis, others X-ray, other would see doctor more often during the day than other patients. There were no standard algorithms of treatment. Doctors could perform medical intervention to them to investigate which treatment is best, but such interventions were not standardized and very often, they could be unnecessary or even harmful for patient. So, at that time, the sphere of medicine was already not a form of art because discoveries in biology and bacteriology are allowed to establish medical facts with which doctors had to deal with. However, it was not completely sphere of science yet as doctors experimented with different kinds of treatment and there were no established standards for treatment as there were also no established standards for conducting such investigations. So, every doctor kept their notes and records about patients, their histories of illness. So, there were no unified data about patients, and there were no unified picture about medicines as well. Because of this diversity in their histories of illness in the way of treatment and prescribing, different kinds of treatment were offered by different doctors. Quality of treatment therefore also varied very heavily from clinic to clinic and even within one clinic. It was impossible to establish treatment procedures that are best for the particular disease because it was impossible to make a comparison of patient records as every doctor make their own notes in their own way and keep in their own tables. In order to make medical system more coherent and to rise the quality of treatment, at the end of the 20th century, different countries to the whole world started to implement a system of standardized record keeping as we know it now. This was one of the first major steps to actual standardization of medical practice. Standardized medical records that use exactly the same classification allow to make comparison between different methods of treatment that doctor use, and they also allow to establish which one of these methods are actually the best. Development and implementation of new technologies and laboratory tests and separation of medical practice into areas of expertise, like gynecology, gastroenterology, and et cetera, bring three important changes within the healthcare practice. First challenge and first change, development of new technologies and introduction of laboratories as a part of clinical practice separated medical practice from medical science. So, doctors now do not usually conduct their own medical experiments on patients, but they provide treatment according to the established standardized HIM. Second challenge is that medical practice itself become very, very diverse and standardized. It is rare that a single doctor delivers a treatment for patients. It is usually a group of experts, including physician, nurse, laboratory technician, maybe some particular expert like gastroenterologists who deliver the whole course of treatment. The specialist may not even communicate with each other in person, but it's a medical record that is a tool that each of them use to extract the necessary information that they need to treat a patient. The third challenge that happened is that doctors and patients become much more separated from each other as it was, for example, two centuries ago, where the medicine was a state of art. Treatment, as well as patients, actually become standardized. A disease is no longer black box for doctor, but it is described and explained in guidelines and standardized recommendations. Patients are holders of diseases. They may not even build a bond with their doctors. They do not need that anymore. Often, patients may not know even who had access to their histories of illness. General practitioners, surgeon, or nurse, they do not know this information. The sphere of medicine become much more specialized, much more standardized, but at the same time, much more depersonalized.
