The Reasoning of the Strongest: The Polemics of Skill and Science in Medical Diagnosis

This paper describes the efforts of clinical scientists and computer experts to introduce computer diagnosis into the wards of a major Australian teaching hospital during the 1960s and 1970s. A logical-empiricist procedure construed as a `scientific' model of medical diagnosis — and thus challenging traditional physicians' claims of `craft knowledge' — had the potential to define a new social and institutional role for clinical research. In this account, the `craft' and `scientific' representations of diagnosis are treated symmetrically, as discursive resources used in a hospital context to legitimate the divergent competences of two competing occupational subgroups. Neither `skill' nor `science' is privileged as an explanatory framework. Attributions of skill — as of rationality — may serve distinct social goals and institutional interests. In order to secure a place for this diagnostic technology clinical scientists appealed to a scientific method that physicians were prepared to use rhetorically to bolster their diagnoses — but not, in the end, to redefine the diagnostic process. The institutional authority of physicians in this case allowed them to ignore a model of diagnosis that would circumvent their control of a crucial aspect of medical work.