ABSTRACT
This chapter argues that the contradictory state of affairs calls for deliberate and persistent efforts to redefine medical expertise so that practitioners, their organisations and society at large may begin to see and pursue expansive ways out of the seemingly uncontrollable situation. Forces and demands from multiple directions mould medical work and expertise. In medical work, a natural starting point for an activity-theoretical analysis of expertise is to examine the interplay of the activity system of the physician and the activity system of the patient. In health care, the transition is driven by the increasing prevalence and importance of chronic illnesses and co-morbidity, the appearance of multiple simultaneous illnesses in a patient. In the socio-spatial dimension, it typically means shifting the focus from an individual patient’s specific symptom or illness towards the complex webs of life and care of the patient. Collaborative and transformative expertise emerges through mundane daily decisions and actions taken by practitioners and their patients and clients.
