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Transformation of the Patient-Physician Relationship from the Magic Touch to Contactless Treatment: The Human Consequences of Robotic Surgery

Year 2020, Volume: 40 Issue: 1, 467 - 497, 23.07.2020

Abstract

The new order of relationships financial capitalism brought about by circulating abstract values has fluidized the basic logic of social action. As a result, while social identification has become ambiguous, the constantly reconstructed interactions have replaced solid structures. The field technology occupies in social life is gradually expanding, and the sociality established by fluid relations becomes possible only with the quantitative diffusion and qualitative development of technology. This process relates not just to technical, material, and structural elements but also signifies a deeper moral transformation and change in human relationships. Professions feel the direct consequences of technologization. The transformation of professions that deal with vital issues and that are obliged to adapt themselves to the innovations by their very nature can be treated sociologically as a kind of litmus paper. In this way, both the direction of social change can be determined and the factors affecting it can be analyzed. In this field study, we examine the process of robotic surgery by conducting in-depth interviews with 15 physicians using Da Vinci surgical systems and robotics. We found robotic surgery to be able to substantially transform both materially and spiritually the phenomenon of touch, which is intrinsic to the nature of healing as the main function of medicine. By claiming the privilege of the magic touch that had been attributed to physicians since ancient times to have been replaced by contactless relationships established through interfaces, we argue that this change in medicine can in fact be treated as a sign and an ideal type of a more general social-moral transformation. In this article, we examine the characteristics of touch; how surgeons perceive their professions, themselves, and their patients in this technologized process; and how they experience the conceptual results of Da Vinci.

References

  • Başkavak, G. (2016). Understanding surgical craft in the changing context of technology, transformation of healthcare and marketization: A case study on surgeons in Istanbul, Turkey (Doctoral dissertation, Orta Doğu Teknik Üniversitesi Sosyal Bilimler Ensitüsü, Ankara, Turkey). https://tez.yok.gov.tr/UlusalTezMerkezi/
  • Baudrillard, J. (1990). Le système des objets. Éditions Gallimard.
  • Baumgart, D. C., Wende, I., & Grittner, U. (2017). Tablet computer enhanced training improves internal medicine exam performance. PLOS One, 12(4), 1–14.
  • Bourdieu, P. (1979). La distinction: Critique sociale du jugement. Les Éditions de Minuit. Bourdieu, P. (1987). Choses dites. Les Éditions de Minuit.
  • Bourdieu, P. (2000). Esquisse d’une théorie de la pratique. Les Éditions du Seuil .
  • Braverman, H. (1998). Labor and monopoly capital: The degradation of work in the twentieth century. Monthly Review Press.
  • Brown, D. C., Miskovic, D., Tang, B., & Hanna, G. (2010). Impact of established skills in open surgery on the proficiency gain process for laparoscopic surgery. Surgical Endoscopy, 24, 1420– 1426.
  • Canguilhem, G. (1996). Le normal et le pathologique. Quadrige/Presses Universitaires de France.
  • Canguilhem, G. (2002). Études d’histoire et de philosophie des sciences. Librairie Philosophique J. Vrin.
  • Canguilhem, G. (2012). Writings on medicine (S. Geroulanos, Tran.). Fordham University Press.
  • Cavestro, W. (1990). Beyond the deskilling controversy. Computer Integrated Manufacturing Systems, 3(1), 38–46.
  • Delaporte, F. (Ed.) (1994). A vital rationalist: Selected writings from Georges Canguilhem. Zone Books.
  • Derrida, J. (1993). La dissémination. Éditions du Seuil.
  • Duff, E., Miller, L., & Bruce, J. (2016). Online virtual simulation and diagnostic Reasoning: A scoping review. Clinical Simulation in Nursing, 12, 377–384.
  • Ellul, J. (1988). Le bluff technologique. Hachette.
  • Ertan, C. (2017). Dövmeli bedenler, Bir beden sosyolojisi kitabı. Phoenix Yayınevi.
  • Foucault, M. (1976). Histoire de la sexualité I: la volonté de savoir. Gallimard.
  • Foucault, M. (1992). L’archéologie du savoir. Éditions Gallimard.
  • Foucault, M. (1993). Naissance de la clinique. Presses Universitaires de France.
  • Guraya, S. (2016). The usage of social networking sites by medical students for educational purposes: A meta-analysis and systematic review. North American Journal of Medical Sciences, 8(7), 268–278.
  • Habermas, J. (1993). İdeoloji olarak teknik ve bilim (M. Tüzel, çev.). Yapı Kredi Yayınları.
  • Hayles, N. K. (1999). How we became posthuman. Virtual bodies in cybernetics, literature, and informatics. The University of Chicago Press.
  • Hoffman, B. (2001). On the valueladeness of technology in medicine. Medicine, Health Care and Philosophy, 4, 335–346.
  • Kaufmann, J.-C. (1998). Corps de femmes, regards d’hommes. Sociologie des seins nus. Nathan.
  • Latour, B. (2007). Changer de société, refaire de la sociologie. La Découverte.
  • Lock, M., & Nguyen, V.-K. (2010). An anthropology of biomedicine. Wiley-Blackwell.
  • Lu, J. (2016). Will medical technology deskill doctors? International Education Studies, 9(7), 130–134.
  • Marcuse, H. (2002). One-dimensional man. Routledge Classics.
  • Merleau-Ponty, M. (1981). Phénoménologie de la perception. Gallimard.
  • Milon, A. (2005). La réalité virtuelle. Avec ou sans corps? Éditions Autrement. Minor, L. (September 11, 2018). Scope. Stanford Medicine: https://scopeblog.stanford.edu/2018/09/11/ will-doctors-be-replaced-by-algorithms/
  • Morissey, B., & Heilbrun, M. (2017). Teaching critical thinking in graduate medical education: Lessons learned in diagnostic radiology. Journal of Medical Education and Curricular Development, 4, 1–5.
  • Patel, N., Ngo, E., Paterick, T., Chandrasekaran, K., & Tajik, J. (2016). Should doctors still examine patients? International Journal of Cardiology, 221, 55–57.
  • Rosser, J., Lynch, P., Cuddihy , L., Gentile, D., Klonsky, J., & Merrell, R. (2007). The impact of video games on training surgeons in the 21st century. Archives of Surgery, 142(2), 181–186.

Sihirli Dokunuştan Temassız Sağaltıma Hasta-Hekim İlişkisinin Dönüşümü: Robotik Cerrahinin İnsani Sonuçları

Year 2020, Volume: 40 Issue: 1, 467 - 497, 23.07.2020

Abstract

Finans kapitalizminin soyut değerlerin dolaşımı üzerinden kurduğu yeni ilişkiler düzeni, akışkanlık olgusunu temel toplumsal eylem mantığı haline getirmektedir. Bunun sonucunda, toplumsalın tanımı belirsizleşmekte, sürekli yeniden yapılıp bozulan etkileşimler, katı yapıların yerini almaktadır. Teknolojinin toplum hayatında kapladığı alan aşamalı olarak genişlemekte, akışkan ilişkilerden örülmüş toplumsallıklar, teknolojinin nicel yayılımı ve nitel gelişimi sayesinde mümkün olabilmektedir. Bu süreç yalnızca teknik, maddi, yapısal unsurlarla ilgili değildir; daha derinde ahlâki bir dönüşüme, insanın insanla ilişkisinin niteliğinin değişmesine işaret etmektedir. Meslekler, teknolojikleşmenin doğrudan sonuçlarını hissetmektedir. Doğası gereği kendisini teknik anlamda yeniliklere uydurmak zorunda olan, “yaşamsal” olarak nitelenebilecek işlerle uğraşan mesleklerdeki dönüşüm sosyolojik anlamda bir çeşit turnösol kağıdı işlevi görmektedir. Böylece toplumsal değişmenin yönü tayin edilebilir, onu etkileyen unsurlar çözümlenebilir. Bu amaçla yürüttüğümüz saha çalışmasında Da Vinci robotu kullanan 15 hekimle derinlemesine görüşmeler gerçekleştirip cerrahi robot süreçlerini inceledik. Robotik cerrahinin, tıbbın temel işlevi olan sağaltımın doğasındaki maddi ve manevi anlamda ‘dokunma’ olgusunu ciddi şekilde dönüştürebileceğini saptadık. Eski çağlardan beri hekime atfedilen sihirli dokunuş ayrıcalığının yerini arayüzler üzerinden kurulan temassız ilişkinin almakta olduğunu iddia ederek, tıptaki değişmenin aslında genel bir toplumsal-ahlâki dönüşümün işareti ve ideal-tipi olarak çözümlenebileceği kanısındayız. Makalemizde dokunmanın niteliği, hekimlerin mesleklerini, kendilerini ve hastalarını bu teknolojikleşmiş süreçte nasıl algıladıkları ve Da Vinci’nin kavramsal sonuçlarını nasıl deneyimledikleri incelenmiştir.

References

  • Başkavak, G. (2016). Understanding surgical craft in the changing context of technology, transformation of healthcare and marketization: A case study on surgeons in Istanbul, Turkey (Doctoral dissertation, Orta Doğu Teknik Üniversitesi Sosyal Bilimler Ensitüsü, Ankara, Turkey). https://tez.yok.gov.tr/UlusalTezMerkezi/
  • Baudrillard, J. (1990). Le système des objets. Éditions Gallimard.
  • Baumgart, D. C., Wende, I., & Grittner, U. (2017). Tablet computer enhanced training improves internal medicine exam performance. PLOS One, 12(4), 1–14.
  • Bourdieu, P. (1979). La distinction: Critique sociale du jugement. Les Éditions de Minuit. Bourdieu, P. (1987). Choses dites. Les Éditions de Minuit.
  • Bourdieu, P. (2000). Esquisse d’une théorie de la pratique. Les Éditions du Seuil .
  • Braverman, H. (1998). Labor and monopoly capital: The degradation of work in the twentieth century. Monthly Review Press.
  • Brown, D. C., Miskovic, D., Tang, B., & Hanna, G. (2010). Impact of established skills in open surgery on the proficiency gain process for laparoscopic surgery. Surgical Endoscopy, 24, 1420– 1426.
  • Canguilhem, G. (1996). Le normal et le pathologique. Quadrige/Presses Universitaires de France.
  • Canguilhem, G. (2002). Études d’histoire et de philosophie des sciences. Librairie Philosophique J. Vrin.
  • Canguilhem, G. (2012). Writings on medicine (S. Geroulanos, Tran.). Fordham University Press.
  • Cavestro, W. (1990). Beyond the deskilling controversy. Computer Integrated Manufacturing Systems, 3(1), 38–46.
  • Delaporte, F. (Ed.) (1994). A vital rationalist: Selected writings from Georges Canguilhem. Zone Books.
  • Derrida, J. (1993). La dissémination. Éditions du Seuil.
  • Duff, E., Miller, L., & Bruce, J. (2016). Online virtual simulation and diagnostic Reasoning: A scoping review. Clinical Simulation in Nursing, 12, 377–384.
  • Ellul, J. (1988). Le bluff technologique. Hachette.
  • Ertan, C. (2017). Dövmeli bedenler, Bir beden sosyolojisi kitabı. Phoenix Yayınevi.
  • Foucault, M. (1976). Histoire de la sexualité I: la volonté de savoir. Gallimard.
  • Foucault, M. (1992). L’archéologie du savoir. Éditions Gallimard.
  • Foucault, M. (1993). Naissance de la clinique. Presses Universitaires de France.
  • Guraya, S. (2016). The usage of social networking sites by medical students for educational purposes: A meta-analysis and systematic review. North American Journal of Medical Sciences, 8(7), 268–278.
  • Habermas, J. (1993). İdeoloji olarak teknik ve bilim (M. Tüzel, çev.). Yapı Kredi Yayınları.
  • Hayles, N. K. (1999). How we became posthuman. Virtual bodies in cybernetics, literature, and informatics. The University of Chicago Press.
  • Hoffman, B. (2001). On the valueladeness of technology in medicine. Medicine, Health Care and Philosophy, 4, 335–346.
  • Kaufmann, J.-C. (1998). Corps de femmes, regards d’hommes. Sociologie des seins nus. Nathan.
  • Latour, B. (2007). Changer de société, refaire de la sociologie. La Découverte.
  • Lock, M., & Nguyen, V.-K. (2010). An anthropology of biomedicine. Wiley-Blackwell.
  • Lu, J. (2016). Will medical technology deskill doctors? International Education Studies, 9(7), 130–134.
  • Marcuse, H. (2002). One-dimensional man. Routledge Classics.
  • Merleau-Ponty, M. (1981). Phénoménologie de la perception. Gallimard.
  • Milon, A. (2005). La réalité virtuelle. Avec ou sans corps? Éditions Autrement. Minor, L. (September 11, 2018). Scope. Stanford Medicine: https://scopeblog.stanford.edu/2018/09/11/ will-doctors-be-replaced-by-algorithms/
  • Morissey, B., & Heilbrun, M. (2017). Teaching critical thinking in graduate medical education: Lessons learned in diagnostic radiology. Journal of Medical Education and Curricular Development, 4, 1–5.
  • Patel, N., Ngo, E., Paterick, T., Chandrasekaran, K., & Tajik, J. (2016). Should doctors still examine patients? International Journal of Cardiology, 221, 55–57.
  • Rosser, J., Lynch, P., Cuddihy , L., Gentile, D., Klonsky, J., & Merrell, R. (2007). The impact of video games on training surgeons in the 21st century. Archives of Surgery, 142(2), 181–186.
There are 33 citations in total.

Details

Primary Language Turkish
Subjects Sociology
Journal Section RESEARCH ARTICLES
Authors

Ali Ergur This is me 0000-0001-8510-4287

Cansu Çobanoğlu This is me 0000-0001-8788-9532

Publication Date July 23, 2020
Published in Issue Year 2020 Volume: 40 Issue: 1

Cite

APA Ergur, A., & Çobanoğlu, C. (2020). Sihirli Dokunuştan Temassız Sağaltıma Hasta-Hekim İlişkisinin Dönüşümü: Robotik Cerrahinin İnsani Sonuçları. İstanbul University Journal of Sociology, 40(1), 467-497.
AMA Ergur A, Çobanoğlu C. Sihirli Dokunuştan Temassız Sağaltıma Hasta-Hekim İlişkisinin Dönüşümü: Robotik Cerrahinin İnsani Sonuçları. İstanbul University Journal of Sociology. July 2020;40(1):467-497.
Chicago Ergur, Ali, and Cansu Çobanoğlu. “Sihirli Dokunuştan Temassız Sağaltıma Hasta-Hekim İlişkisinin Dönüşümü: Robotik Cerrahinin İnsani Sonuçları”. İstanbul University Journal of Sociology 40, no. 1 (July 2020): 467-97.
EndNote Ergur A, Çobanoğlu C (July 1, 2020) Sihirli Dokunuştan Temassız Sağaltıma Hasta-Hekim İlişkisinin Dönüşümü: Robotik Cerrahinin İnsani Sonuçları. İstanbul University Journal of Sociology 40 1 467–497.
IEEE A. Ergur and C. Çobanoğlu, “Sihirli Dokunuştan Temassız Sağaltıma Hasta-Hekim İlişkisinin Dönüşümü: Robotik Cerrahinin İnsani Sonuçları”, İstanbul University Journal of Sociology, vol. 40, no. 1, pp. 467–497, 2020.
ISNAD Ergur, Ali - Çobanoğlu, Cansu. “Sihirli Dokunuştan Temassız Sağaltıma Hasta-Hekim İlişkisinin Dönüşümü: Robotik Cerrahinin İnsani Sonuçları”. İstanbul University Journal of Sociology 40/1 (July 2020), 467-497.
JAMA Ergur A, Çobanoğlu C. Sihirli Dokunuştan Temassız Sağaltıma Hasta-Hekim İlişkisinin Dönüşümü: Robotik Cerrahinin İnsani Sonuçları. İstanbul University Journal of Sociology. 2020;40:467–497.
MLA Ergur, Ali and Cansu Çobanoğlu. “Sihirli Dokunuştan Temassız Sağaltıma Hasta-Hekim İlişkisinin Dönüşümü: Robotik Cerrahinin İnsani Sonuçları”. İstanbul University Journal of Sociology, vol. 40, no. 1, 2020, pp. 467-9.
Vancouver Ergur A, Çobanoğlu C. Sihirli Dokunuştan Temassız Sağaltıma Hasta-Hekim İlişkisinin Dönüşümü: Robotik Cerrahinin İnsani Sonuçları. İstanbul University Journal of Sociology. 2020;40(1):467-9.