Medical technocracies in liver transplantation: drawing boundaries in medical practices

This article explores the ways in which the mastery of particular medical technologies plays a crucial role in drawing the boundaries between medical specialities, to form what we refer to as medical technocracies. It sets out, above all, to demonstrate how the frontiers between the different medical specialities act, on the one hand, as articulating mechanisms to be found in the division of medical work and, on the other hand, as barriers to the interaction of the various skills. Through a more searching study of the division of labour between surgeons and liver specialists (hepatologists) and surgeons and anaesthetics, we highlight the contrast between those two sets of relations.This illustrates the boundaries and articulation that exist between medical technocracies. The key theoretical guidelines are drawn from medical sociology and sociology of professions. The research methodology includes participant observation in a liver transplantation hospital unit and on site interviews. By using data gathered from physicians actually working in such areas where boundaries have been drawn between surgeons and anaesthesiologists and surgeons and liver specialists, we propose to understand how different medical skills are negotiated between the different groups and where the social arrangements are the result of processes of interaction between the different specialities, which are constantly being reorganized and redefined.