Theorizing Technology and the Transformation of Healthcare

The discourses on telecare described in the previous chapter reflect not only a reductionist view of healthcare; they also rely on a rather restricted view of technology. Actors with vested interests in the promotion of telecare technologies consider these innovations as problem solvers: telecare devices are expected to make healthcare more efficient and affordable. These discourses thus reinforce an instrumental view of technology: technologies are considered as tools that make it possible to realize a specific aim. The history of technology, however, shows many examples of technologies that don’t do what innovators want them to do. Over the past two decades, social studies of user–technology relationships have described the discrepancies between how technologies were initially meant to be used and how users modified technical devices to meet their own goals (Oudshoorn and Pinch, 2003, 2007). The instrumental view of technology, which assumes a direct, causal relationship between aim and effects, has also been criticized because it fails to recognize that technologies transform problems rather than solve them. For example, the introduction of telecare technologies designed to reduce costs by delegating healthcare work partly to patients, telecare workers, and technological devices, may actually increase rather than decrease healthcare spending because the use of telecare technologies may increase the number of diagnoses that require medical treatment.