Circuits of power : a study of the development of computer software and its use in general medical practice : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Sociology at Massey University

Abstract

This thesis explores several phases in the life history of a software package developed in New Zealand for the primary healthcare market in order to show how the package is implicated in maintaining or changing existing distributions of power. The theoretical concepts which inform the study come primarily from Wiebe Bijker who works within the constructivist tradition of technology studies. The methods include documentary research and fieldwork, including open-ended interviews with five people involved with the package at the development site and seven who work in large and small general practice sites. The study concludes that the introduction of computers into general medical practice is associated with a small shift in the balance of power within general practice which has significant consequences for those who are unable or unwilling to acquire computing expertise. It also concludes that computerisation of general practice is associated with changes in the autonomy of general practitioners as their work becomes open to greater surveillance and in the GP-patient relationship where the computer has the capacity to substantially alter the nature of the interaction. The main findings of the study are that the groups most influential in the development of the package continue to exercise their influence as the package is deployed and used in a general practice setting. In this way the package both reflects and reinforces their power as it moves between development and use. The study also shows that those most influential in all phases of the package's existence draw on a number of skills and resources such as business acumen, clinical knowledge and computing expertise but that the most significant resource is money in the form of purchasing power or economic authority.