Objects, contradictions and collaboration in medical cognition: an activity-theoretical perspective.

Activity theory suggests three principles for contextual analysis of clinical cognition: orientation to objects in cognition, role of contradictions in cognition, and the importance of collaboration in cognition. Focusing on the objects of cognition calls attention to differences across medical work settings. There is an interconnection between the type of the object encountered, the physician's generalized conception of the object, and the physician's choice of linearization or lateralization as cognitive strategy. In a consultation the object of medical cognition is locally constructed through a series of mediated actions. Identification of contradictions at the level of the institutional activity system is crucial for the understanding of failures and innovations in actions of medical cognition. A conceptual model for analyzing such contradictions is presented. It is demonstrated that medical cognition is a collaborative achievement between the physician and the patient. Patients use a variety of strategies to turn their experienced health problems into manageable problems. The patient's strategy can and often does influence the physician's strategy and the outcome of the consultation.