SEMIOLOGIC ANALYSIS OF A NEW PHYSICIAN ROLE
SEMIOLOGIC ANALYSIS OF A NEW PHYSICIAN ROLE
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新医生角色的符号学分析
DOI：
10.1203/00006450-198404001-00820
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发表时间：
1984
影响因子：
3.6
通讯作者：
S. Gidding
中科院分区：
文献类型：
--
作者：
S. Gidding
新技术改变了人们行医的方式。我们认为，这些新技术在医学上的影响可以用罗兰·巴特发展的符号学概念来最好地理解。组合是构成逻辑陈述的关联的线性序列。例如，菜单上的课程序列形成了一个组合；列出的特定课程的选项形成了一个关联。医疗实践的一个典型组合是一系列关联：病史、体检、鉴别诊断、诊断计划、治疗计划、结果评估。更老的独立技术，如目前的疾病、听诊器、化学分析和X射线，加强了这种组合，因为作为关联的贡献在被医生纳入完整的组合之前没有临床意义。更新的交互技术，如二维超声心动图或胰岛素泵，可以快速获取数据，供计算机或熟练操作员进行顺序分析，然后他们可以实现预期的结果(正常血糖、心脏诊断)。这项新的互动技术取代了医生作为独立联想合成者的经典组合的角色。因此，许多主要管理技术的医生参与了一个新的组合--患者数据库、交互技术、交互结果--导致了与传统组合创建的不同的角色模型。对新医生角色的认识对医生培训、人力评估和自我理解具有重要意义。
New technologies have altered the way medicine is practiced. We propose that the influence of these new technologies in medicine may best be understood using the semiologic concepts of syntagm and association as developed by Roland Barthes. A syntagm is a linear sequence of associations which make a logical statement. For example the sequence of courses on a menu forms a syntagm; the listed choices for a particular course form an association. A classic syntagm which epitomizes medical practice is the sequence of associations: history, physical exam, differential diagnosis, diagnostic plans, therapeutic plans, outcome assessment. Older independent technologies such as the present illness, stethoscope, chemical analyses, and x-ray, strengthen this syntagm because the contributions as associations do not have clinical meaning until they have been incorporated into a complete syntagm by a physician. Newer interactive technologies such as 2-D echocardiogram or insulin pump can rapidly acquire data for sequential analysis by a computer or skilled operator which (who) can then achieve the desired outcome (euglycemia, cardiac diagnosis). The physician's role in the classic syntagm as synthesizer of independent associations is usurped by this new interactive technology. Thus, many physicians who primarily manage technologies participate in a new syntagm--patient-data base, interactive technology, interaction outcome--resulting in a different role model than that created by the classic syntagm. Recognition of new physician roles has implications for physician training, man power assessments, and self-understanding.