Cutting Surgeons, Walking Patients: Some Complexities Involved in Comparing

Abstract

Annemarie MolCutting surgeons, walking patients Some complexities involved in comparingIn health care most facts come as comparative facts.Few conditions or treatments are ever treated as simply good or bad -as if there were absolute standards.Rather, they are better or worse: than they were; than their alternatives; than an agreed threshold; than might be expected.Thus assessments involve comparisons.But this means that they raise the question what is similar and different between different situations.So how might similarity and difference be mapped?If we look at this closely it turns out to be complex rather than simple.In this chapter I explore some of the complexities involved in comparing treatments with one another -which also implies a study of another kind of comparison: that of the conditions of patients before and after treatment.This is what lies behind my inquiry.Making comparisons implies simplification.But what kind of simplification?What is to be skipped, bracketed, smoothened or left out?And how might simplifications be made in such a way that the world isn't flattened?If we want to begin to get an insight into these questions, we also need to keep the platforms in view, the platforms upon which comparisons are made.So the question is: where are all the comparisons, and what are the effects of making them?In this chapter I will explore these broad questions by looking at a single (simple?) case.This is a comparison of walking therapy and operations as treatments for arterial disease in what medicine calls 'the lower limbs'.The material for this study was mainly gathered in two university hospitals in the Netherlands, hospital Z and hospital G.There we (my research assistant Jeannette Pols and myself) spoke with medical professionals, technicians and patients and observed practices of diagnosis and treatment.We also read relevant medical literature, and spoke with general practitioners, physical therapists and patients working or treated elsewhere in the Netherlands. 1

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