Alexandre Mathieu-Fritz, Le praticien, le patient et les artefacts. Genèse des mondes de la télémédecine, Presses des Mines, Collection Science Sociales, Paris, 2021
10.6092/issn.2038-3460/17995
application/pdf
2038-3460
17995
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Arianna Radin
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Tecnoscienza – Italian Journal of Science & Technology Studies
Alexandre Mathieu-Fritz, The practitioner, the patient and artefacts. Genesis of the worlds of telemedicine, Presses des Mines, Collection Science Sociales, Paris, 2021
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Book Reviews
2023-09-26
2023-09-13
2023-09-26
2023-09-26
183-186
TS
Arianna Radin
2023/09/26
10.6092/issn.2038-3460/17995
183
CNR-IRCrES
2038-3460
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186
Alexandre Mathieu-Fritz, The practitioner, the patient and artefacts. Genesis of the worlds of telemedicine, Presses des Mines, Collection Science Sociales, Paris, 2021
https://tecnoscienza.unibo.it/article/download/17995/16775
14
T/S                                                                                                      BOOK REVIEWS



Le praticien, le patient et les artefacts. Genèse des mondes de
la télémédecine
[The practitioner, the patient and artefacts. Genesis of the
worlds of telemedicine]

by Alexandre Mathieu-Fritz (2021) Presses des Mines, Collection Science Sociales, Paris.




Arianna Radin
CNR-IRCrES


   Le praticien, le patient et les artefacts. Genèse des mondes de la télémédecine is a book by Alex-
andre Mathieu-Fritz, a sociologist of work and professional groups at Gustave Eiffel University,
who focuses his recent studies on teleconsultations in different medical fields and on telemedi-
cine in general. The book proposes the issues of professional practice, patients, and artefacts in
the field of telemedicine through concrete French cases. The text is organized into three sections:
the first dedicated to the changes in French telemedicine, the second to the new forms of coop-
eration in teleconsultations, and the third to the recomposition of practices and therapeutic re-
lationships in mental health teleconsultations. The second and third sections each have an intro-
duction that allows you to get to know the specific object of study better, specifically Télégéria
and Télé-Med. The different sections are not homogeneous in terms of number of chapters:
the second section is decidedly wider than the others, while it would have been better to devote
more space to the first. An introduction and a general conclusion open and close the book.
   The introduction is the compass of the book: in addition to anticipating the organization
of the following pages to the reader, the author specifies the objective of the book:

                       to observe the dynamics of the development of French telemedicine starting from the
                       point of view and the concrete activities of the professionals who experience it, in a period
                       (2009-2019) in which it constitutes an innovation in the process of being institutionalized.
                       (p.11, my translation from French)

  As the author himself underlines, the book is therefore a pre-Covid 2019 snapshot situated
before the socio-health crisis that forced everyone to deal with remote medical assistance.
  The first section is entirely dedicated to providing the historical framework of telemedi-
cine in France and the theoretical framework of reference for the book. In fact, the author
distinguishes the history of telemedicine in France into four major periods: the pioneering

 CNOSIEZA
        T . taI lian Journal fo Scienec & echnT ogyl tud
                                                       S ies                            © The Author(s) 2023
)14( p. 1863- ISN 2038-46                                                               Attribution 4.0 International (CC BY 4.0)
         DOI: 10.692/isn/1795.2038-46                                                   www.tecnoscienza.net
Radin                                                                                           184

phase, starting in the 1980s; the experimental phase of the two-years period 2009-2010; the
institutionalization phase that lasted a decade (2010-2020); finally, the acceleration phase,
caused by the 2020 pandemic. Providing an accurate historical description of telemedicine in
France means first of all accompanying the reader on a tortuous path made up of acronyms
and definitions. The decoding of the many French acronyms is not simple and perhaps an
appendix would have been needed to disentangle between SFSD (Société Française de Santé
Digitale), SNITEM (Syndicat National de l’Industrie des Technologies Médicales) or URPS
(Unions Régionales des Professionnels de Santé), just to mention a few examples. The defini-
tions of telemedicine, teleconsultation, telesurveillance, teleassistance and tele-expertise are
clearly stated and are really useful for understanding the author’s frame of reference. Par-
ticularly interesting is the clear distinction proposed between telemedicine and telehealth
(télésanté) which re-proposes the WHO definitions: the first oriented towards medical and
clinical aspects, the second towards public health, and therefore also including health edu-
cation for all. After these necessary and punctual distinctions, as was logical to expect from
a volume published in 2021, the author dedicates an entire paragraph in the first chapter of
the book to the “boom” (in the original text) of teleconsultations starting from 2020. In
fact, also in France, it’s possible to observe an increase, legally endorsed, of telemedicine and
teleconsultations during the French lockdown caused by the social and health emergency of
COVID-19. A new habit – which could become custom, it is underlined – which has allowed
some healthcare professionals to show that they have basic knowledge of telemedicine, but
which has led others to feel compelled to use new tools for “war telemedicine” (p.50). An
entire chapter of this first section is dedicated to the “new model of sociological analysis”
(“un nouveau modèle d’analyse sociologique” in original). From a theoretical point of view,
the book moves openly in the tradition of the sociology of professionals, such as Hughes,
Strauss, Abbott, and Zetka, and in the French interactionist sociology of professional groups,
particularly Dubar and Tripier, and their studies of professional dynamics. There are also ref-
erences to pragmatic sociology, in particular to Dodier (1995) and his proposal of a “technical
solidarity” (“solidarité technique” in original) that is formed through technology and its uses
and consists of the links between non-human and human actors. There are also most recent
references to the sociology of activity by Bidet (e.g., 2010) and Licoppe (2008): the first with
her research on “real work” (“vrai boulot” in original) or the description of the personal or
subjective relationship between work activity and worker, which seeks to enhance its activity;
the second with his model of analysis of the “activities square” (“carré de l’activité” in original)
which is an ethnography of work situations that allows observing the shared interactive space
and the relationship with the tools, intended as interactional artefacts.
   The other two sections are dedicated to two distinct telemedicine projects which allow ob-
serving both therapeutic relationships and interprofessional cooperation: the case study of
Télégéria is proposed as an example of traditional teleconsultation for geriatric patients and oc-
cupies the second section of the book, while Télé-Med, to which the third section is dedicated,
is an example of dyadic teleconsultation in the field of mental health. As extensively discussed
in the text, the Télégéria study was carried out through the observation of technical sessions,
without patients but the scientific coordinator of the project, semi-structured interviews with
health professionals, and observation of teleconsultations with patients between 2009 and
185                                                                         Tecnoscienza. 2023. 14(1)

2011. The project envisaged teleconsultations of specialists – for example, orthopaedic sur-
geons, and dermatologists – provided to geriatric clinic patients in the presence of geriatricians.
The proposed analysis of the first case brings out two main themes. The first has to do with
the long tradition of Abbott’s sociology of professions relating to the importance of defining
jurisdictional space and building skills, understood however as medical and not technological
skills: an example is that of diagnostic palpation taught by surgeons in orthopedics to geriatri-
cians. The second theme is interconnected with the first since it is the lack of corporeity – the
absence of the tactile ritual, as it is effectively written in the book – that obliges professionals to
disseminate medical knowledge and care practices in the absence of direct contact with patients
through a web connection. The second case study, Télé-Med, seems instead to use the absence
of presence in the same physical space for the benefit of therapy. The comparison of assist-
ed-mental health professionals via a dedicated platform allows the former to be less intimidated
and the latter to concentrate on the relationship. The platform supplied a list of professionals
to permit the patient to be informed on the type of orientation of the consultation – e.g.,
humanistic approach or cognitive behavioral therapy – and it took care of the construction of
the availability and appointments agenda, and the payment of the performance. The research
ended in 2014, long before the health emergency that introduced similar applications in Italy
as well. Also in this case the author carried out interviews with the psychotherapists involved
in the project, and interviews with two experts in mental health and teleconsulting. The in-
terviews, as the teleconsultations, were carried out via Skype, but in this case study was not
possible for the researcher to attend the teleconsultations because of confidentiality.
   From the point of view of the definition of the context, the text is very interesting because
it clearly and convincingly proposes the distinction between telemedicine and télésanté, as al-
ready underlined, even managing to arrive at the better-known and shared eHealth. However,
instead of adopting a culturalist point of view, a juridical vision of the phenomenon is opted
for which, while helping to understand the legitimation process in the French context, does
not allow the reader to better understand the training and behavioral gaps in terms of digital
knowledge and expertise of health professionals, underlined in the text, but not adequate-
ly supported by the proposed literature. Inevitable but underdeveloped also the theoretical
references to STS, in particular to Latour’s (1994) technical objects considered as actors and
Callon’s (1986) process of translation. As often happens in publications collecting experienc-
es from the past, even if it is recent, there is a lack of updating in light of what has emerged
with the Covid-19 emergency and the possible new technological innovations available at the
time of reading. The curiosity remains to understand how lasting these teleconsultation tools
are to time and the eHealth market (from the point of view of patients in particular).
   The author in the conclusions explains that the book intends to propose telemedicine not
as a new therapeutic modality but as a new organizational and technical configuration of
medicinal and treatment practice. That means new habits, after a period of adaptation and
confidence with new tools, new actors, and a new configuration of interprofessional teams.
   For these reasons, the book is an interesting read, for scholars involved in STS and in par-
ticular for those who work in the field of healthcare, mental health, and health professionals.
In general, it is inspiring for those who are interested in learning about the French point of
view in the field of telemedicine, just before Covid-19.
Radin                                                                                                   186

References

Bidet, Alexandra (2010) Qu’est-ce que le vrai boulot? Le cas d’un groupe de techniciens, in “Sociétés
   contemporaines”, 78, pp.115-136.
Callon, Michel (1986) Eléments pour une sociologie de la traduction: La domestication des coquilles Saint
   Jacques et des marins-pêcheurs dans la baie de Saint-Brieuc, in “L’Année Sociologique”, 36, pp. 67-86.
Dodier, Nicolas (1995) Les hommes et les machines: La conscience collective dans les sociétés technicisées,
   Paris, Métailié.
Latour, Bruno (1994) Une sociologie sans objet? Remarques sur l’interobjectivité, in “Sociologie du Travail”,
   36(4), pp. 587-607.
Licoppe, Christian (2008) Dans le “carré de l’activité”: Perspectives internationales sur le travail et
   l’activité, in “Sociologie du Travail”, 50(3), pp. 287-302.
