Dissertation Research: Managing Diagnostic Uncertainty: An Examination of the Interplay of Technology, Medical Knowledge, and Law in Diagnostic Practice. The Case of Epilepsy.

这是一项科学技术研究论文改进资助。该项目是一个比较，民族志分析医生的策略，以管理在当代美国医学癫痫诊断面临的竞争医疗和法律要求。这笔赠款将用于支付参加几次会议的旅费。资金还将用于设备采购。研究人员将在高度不确定的医学背景下研究技术、医学知识和诊断实践之间的相互作用，在这种背景下，医生不仅是诊断医生，而且是癫痫患者驾驶法律监管的关键参与者。最后，研究人员将探讨诊断实践对患者的影响。被诊断患有各种癫痫的人建立了支持和倡导团体，这是他们分享医疗和法律知识、对诊断经验作出反应并努力挑战法律法规的关键场所。本研究将这些社会群体作为产生关于癫痫的替代医学知识的重要场所，在患者（以及医生自己）有时认为医生的知识不足的情况下。研究活动将进行超过16个月，包括人种志：1.)综合癫痫诊所，2.)患者支持小组（美国癫痫基金会北加州分部），3.)北加州DMV委员会的几个分支机构，该委员会决定吊销患者的驾驶执照，以及在一些重要的科学和医学会议上的参与者观察。本研究将试图描述不确定性何时以及如何成为问题，何时以及如何结束争议，以及何时以及如何保持开放。通过详细说明诊断是如何产生的，本研究可以被患者用来了解自己的诊断过程，并有助于改善医患沟通。

This is a Science and Technology Studies dissertation improvement grant. The project is a comparative, ethnographic analysis of doctors' strategies for managing competing medical and legal demands faced in diagnosis of epilepsy in contemporary American medicine. Funds from this grant will support travel to several conferences. Funds will also support equipment purchases. The researcher will examine the interplay of technology, medical knowledge, and diagnostic practice, within a medical context of high uncertainty, where doctors are not only diagnosticians, but also key players in the legal regulation of driving for people with epilepsy. Ultimately, the researcher will explore implications of diagnostic practice for patients. People diagnosed with various seizure disorders have created support and advocacy groups, which are key sites where they share medical and legal knowledge, react to their experience of diagnosis, and work to challenge legal regulation. This research takes these social groups as an important site for the generation of alternate medical knowledge about epilepsy in cases where doctor's knowledge is sometimes taken as insufficient by patients (as well as doctors themselves). The research activities will be conducted over 16 months, and will include ethnography of: 1.) a comprehensive epilepsy clinic, 2.) a patient support group (Northern California Branch of the Epilepsy Foundation of America), and 3.) several branches of the Northern California DMV Committee that makes decisions to revoke patient's driver's licenses, as well as participant-observation at a number of key scientific and medical meetings. This study will attempt to delineate when and how uncertainty becomes problematic, when and how controversy is closed and when and how it is left open. By detailing how diagnoses are produced, this study may be used by patients to inform themselves about the diagnostic process and may contribute to improved doctor-patient communication.