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Comment rationaliser sans standardiser la médecine? : Production et usages des recommandations de pratiques cliniques

Abstract : Using both a survey of social science literature on medical guidelines and different research fields they investigated themselves (especially on cancerology), the authors suggest a sociological analysis of the current rationalization process of medicine through the production and the use of medical guidelines. The historical perspective shows that what is at stake in the long term rationalization process of medicine is not only the autonomy of the medical profession nor the stratification of the profession between the clinicians and the experts physicians but also the definition of the balance between the pursuit of objectivity that is supposed to make medical work easier and the protection from external controls on medical practices (from the State, from the National Health Insurance and from patients). Our findings are that the rationalization process of medicine is not new and is part of the historial dynamics of the medical profession but its presents some recent specificities (its collegiality and recursiveness). Moreover, this rationalization is rather a professional rationalization that preserves the autonomy of the clinical judgment and the possibilities of adaptations in a given local implementation context than an industrial rationalization that would imply the definition of a formal and standardized link between diagnosis and treatment classifications and would facilitate external controls on the medical practices. The article analyses first the way the medical guidelines are produced in France and secundly the way the guidelines are used by the physicians and by other actors.
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https://halshs.archives-ouvertes.fr/halshs-00587065
Contributor : Patrick Castel <>
Submitted on : Tuesday, April 19, 2011 - 12:17:10 PM
Last modification on : Thursday, May 14, 2020 - 11:56:06 AM

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  • HAL Id : halshs-00587065, version 1

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Patrick Castel, Magali Robelet. Comment rationaliser sans standardiser la médecine? : Production et usages des recommandations de pratiques cliniques. Journal d'Economie Médicale, 2009, 27 (3), pp.98-115. ⟨halshs-00587065v1⟩

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