In our research on doctor-patient interaction in primary care clinics, we
did identify and discuss a specific, concrete-historical sense in which the
visit itself became the object. This was when the physicians were held
accountable for their performance primarily by counting the number of
patient visits they had per a time unit. At that time, also the tools and
the rules of the activity were built to support a visit-centered approach
in the physicians' work. You might say that the substance of the object -
the patient's illness or problem - became molded into the form of the visit
as a unit of calculation and control. This substance-form dialectic is
closely related to the dialectic of use value and exchange value.
However, our data does not indicate that the visit was the object for
patients. For them, the object was their illness, pain, discomfort, worry,
or other such problem. The substance-form dialectic for patients seemed to
be primarily that of problem or illness (as substance) / certification for
medication, sick leave, further tests or such (as form).
Now these are just one set of perspectives on the object in the medical
settings we studied. Another perspective would be to look at the types of
illness/problem taken up by patients in the encounters. To give you a
flavor of analysis in this perspective, here is a quote from a paper titled
'Objects, contradictions and collaboration in medical cognition: An
activity-theoretical perspective' (Engestr=F6m, 1995).
"In other words, health center physicians need to be able to switch
strategies depending on the type of the case they are facing. The cases
range from (a) straightforward and oft-repeated problems such as common
colds, to (b) rare but potentially life-threatening diseases such as breast
cancers at their early stages, and to (c) frequent but each time very
different cases with multiple, often vague, social, psychological and
non-serious biomedical problems. It seems that forward reasoning and
pattern matching are often used in the simple cases of type (a), while
backward reasoning and generating and testing of hypotheses are often used
in the biomedically potentially serious cases of type (b).
Cases of type (c), or multi-problem cases for short, are the least
understood and most intriguing type."
I hope this conveys something about the ways in which I prefer to use the
concept of object. For instance, I don't think it's useful to treat the
notion of object simply as a momentary feature of any situation of
interaction. In activity theory, the concept of object is anchored at the
level of historically evolving collective activity systems. Without
historical analysis and historical data, it is very hard to make sense of
objects.
I'm not trying to tell others how they should think about and apply
activity theory. I'm simply trying to tell what I think about it.
Cheers,
Yrjo Engestrom
Reference:
Engestr=F6m, Y. (1995). Objects, contradictions and collaboration in medical
cognition: An activity-theoretical perspective. Artificial Intelligence in
Medicine, 7, 395-412.