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SEMIOLOGIC ANALYSIS OF A NEW PHYSICIAN ROLE

New technologies have altered the way medicine is practiced. We propose that the influence of these new technologies in medicine may best be understood using the semiologic concepts of syntagm and association as developed by Roland Barthes. A syntagm is a linear sequence of associations which make a logical statement. For example the sequence of courses on a menu forms a syntagm; the listed choices for a particular course form an association. A classic syntagm which epitomizes medical practice is the sequence of associations: history, physical exam, differential diagnosis, diagnostic plans, therapeutic plans, outcome assessment. Older independent technologies such as the present illness, stethoscope, chemical analyses, and x-ray, strengthen this syntagm because the contributions as associations do not have clinical meaning until they have been incorporated into a complete syntagm by a physician. Newer interactive technologies such as 2-D echocardiogram or insulin pump can rapidly acquire data for sequential analysis by a computer or skilled operator which (who) can then achieve the desired outcome (euglycemia, cardiac diagnosis). The physician's role in the classic syntagm as synthesizer of independent associations is usurped by this new interactive technology. Thus, many physicians who primarily manage technologies participate in a new syntagm--patient-data base, interactive technology, interaction outcome--resulting in a different role model than that created by the classic syntagm. Recognition of new physician roles has implications for physician training, man power assessments, and self-understanding.