UCSF

This dissertation explores how the circulation of medical information into new places reshapes notions of expertise, trust, and medical authority among groups of clinical specialists. My case study is an examination of how the adoption of PACS (picture archiving and communication systems), an information technology which allows for the instant circulation and display of images on computer workstations throughout hospitals and beyond, has eroded radiologists' claims for authoritative knowledge over the interpretation of medical images. Through an ethnography of the daily practices of radiologists and non-radiology clinicians at a large tertiary-level academic hospital in the U.S., I show how the adoption of PACS enables medical images to become newly mobile and circulate beyond the control of radiologists, producing the following unintended consequences: 1) a newly intimate relationship between clinicians and medical images; 2) a marked reduction in clinician interactions with radiologists; and 3) the emergence of claims among clinicians for expertise in interpreting medical images.

I argue that changes in medical authority and knowledge produce opportunities for the renegotiation of claims for expertise among groups of physicians. This study increases our understanding of how boundaries of expertise and authority are socially negotiated. It reveals how these boundaries and their negotiations impact concepts of risk, responsibility, patient care, and professional identity in medicine.