[The protocols and the medical decision: evidences based in experience or existence?]

Area of Science:

• Science and Technology Studies (STS)
• Medical Epistemology
• Sociology of Science

Context:

• Examines the integration of practical, experience-based knowledge with formal, probabilistic models in clinical settings.
• Focuses on the consensus-building processes and criteria used for medical diagnostic and therapeutic decisions.
• Draws upon Ludwik Fleck's concept of thought collectives and the contingent nature of scientific facts.

Purpose:

• To analyze the conceptual frameworks and interests driving the transformation of practical knowledge into probabilistic epistemological models.
• To investigate the argumentation and practices involved in establishing valid knowledge criteria for clinical decision-making.
• To understand the role of external agents (government, medical-industrial complex) and internal factors (clinician skepticism) in protocol adoption.

Summary:

• Ethnographic observation of a cardiology Intensive Care Unit (ICU) in Rio de Janeiro, analyzing medical rounds and meetings.
• Utilizes Knorr-Cetina's concept of transepistemic arenas and Perelman's argumentation theory for analysis.
• Findings indicate a trend towards incorporating cost-benefit analyses and diverse agent interests into clinical protocols, alongside an ambivalent use of scientific studies and clinical experience.

Impact:

• Highlights the influence of economic and political factors on medical knowledge and practice.
• Reveals clinician ambivalence towards formal analytical tools and epidemiological thought styles.
• Suggests a gap between the theoretical underpinnings of evidence-based medicine and its practical application in complex clinical environments.