Grant: Project Grant

In the last thirty years, modern surgery has undergone a major revolution. Open operations have largely been replaced by an alternative: minimally invasive surgery (MIS). In MIS, surgeons insert laparoscopic visualization devices and other miniaturized surgical tools through small incisions to the abdomen. In the late 1980s and early 90s, in the space of less than five years, MIS became the technique of choice among general surgeons in North America and Europe. This rapid uptake has been widely explained as a patient-driven revolution, in which the "patient consumer" was a major player. However, we do not know, for instance, how patients actually influenced surgical therapy, especially in countries with predominantly public healthcare systems. Focusing on Canada and the USA, our proposed project asks, among other things, how exactly patients put pressure upon surgeons, how they communicate with one another to voice approval or express dissent. Answering these types of questions will help in understanding and defining the role of the patient-consumerism in modern healthcare. This history will provide a comparative analysis of patient consumerism at the end of the twentieth century, looking at its various manifestations and its limitations. The proposed project will thus be a major contribution to the still little explored history of MIS as an important and ever-evolving technology in modern surgery, and, more generally, to the history of technological innovation in modern medicine with its technical, scientific, social and cultural aspects. At the same time, it will help understand the changing role of patients in shaping modern medicine and its technologies. Its results will thus provide a better basis for future policy decisions about supporting and guiding technical innovation health care in accordance with the demands of the population.