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Morten Sager

What can philosophy of science bring to health care research? A lot, says Morten Sager, senior lecturer in philosophy of science.
Sager investigates, along with colleagues within the subject area and researchers in social medicine at Sahlgrenska, how the new standardised guidelines for sick leave time are applied in everyday practice. 
– Our project concerns the insurance medical decision support, which is a comprehensive reform to make the sick leave process more coherent across the entire nation. Through this decision support, the health care system and the Social Insurance Agency are to receive formal guidelines in assessment of a person's work capacity vis-á-vis a particular state of illness or diagnosis. We have unfortunately found that there is a lack of research and competence in terms of the most central elements in the entire process – i.e. that which the decision support is meant to standardise – namely the assessment of people's work capacity, i.e. when, how much and with what one can actually work when afflicted by a particular state of illness.

So the standardised guidelines risk grinding against reality?
– The question of people's actual work capacity is, in many ways, not answered through the type of formalised simplification that the decision support entails. One has, so to speak, put the cart before the horse. Instead of investing resources for competence growth within various occupational groups that are later simplified in decision support, one has tried to standardise something of which few people have any knowledge. It will obviously not be helpful to homogenise assessments of work capacity when few people in real life have the basic ability to make assessments of work capacity – rules of thumb can simplify things for a competent person, but cannot transfer competence per se.

Have you worked with a similar set of problems in a project on evidence-based medicine?
– Yes. I have previously investigated how evidence – or more bluntly the best available knowledge – is acquired, disseminated and used, above all within heart health care. Various actors within the health care sector may, however, be referring to different things when using the term "evidence", depending on what task one has within the entirety. Therefore, the choice is most often not between evidence and ignorance, but between evidence and evidence. Then, things suddenly become quite complicated.

Why are you interested in the tension between abstract theory and concrete reality?
– Firstly, because this is the very crux of the matter in all research. How does one reach out to the people who need the research results, be they about new medicines, treatments or – to take a more humanist research example – a different perspective on the world. Secondly, researchers often underestimate the specific circumstances in that which is local, individual and everyday. A lot of research is based on abstraction and that is all very well – as long as one knows that half of the work remains.

Can philosophy of science build bridges between the world of research and practical health care activities?
– Much more so than is presently the case. As a theorist of philosophy, one is often the only one who has talked to people along the entire chain, from the National Board of Health and Welfare to the regional authorities, the treating physicians and the patients. This experience enables one to acquire a keen gaze for which issues, needs and possibilities exist in various places in the system. Concurrently, one has as a theorist of philosophy an analytical competence for abstracting and analyzing. In this respect, one possesses a great potential to create overarching understanding and build bridges. One such specific bridge is what I am working with at the moment, namely a Master's programme in evidence basing. The thought here is both to pass on methodological knowledge on evidence basing, but also to increase reflection around the effect standardisations and evaluations have on the concrete care and health care work.

Personal facts

Employment: senior lecturer
Age: 39 years
Family: married with two children
Research interests: actor-network theory (ANT), Science and Technology Studies (STS), evidence-based medicine
Driving force: I want to understand and make a difference.
Leisure interests: active within the church (if that can be described as a leisure interest!), TV series, films and literature, as well as fitness sports such as running, paddling and inline skating.

[Interview by Daniel Brodén and published 2012-10-16]

Contact Information

Centre for Culture and Health

Box 200, 405 30 Gothenburg, Sweden

Page Manager: Lovisa Aijmer|Last update: 10/16/2012

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