Sensory work of diagnosis: A crisis of legitimacy

Abstract

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.