The Study Of Expertise And The Public Decision-making In Medicine

Followed with science and technology is increasingly differentiated and highly specialized, an expert in one field is a layman in other fields, and the public can also acquire some expertise in given context. The relationship between expertise and the public becomes one of the most important topics in contemporary academic circles. In medicine, since expanded programme on immunization is implemented in China in2007, there are increasing vaccination events and disputes on childhood vaccination. At the same time, in some extent, the high rate of overall childhood vaccination conceals the public demand and the decision-making reason. Then understanding why and how parents vaccinate for their children becomes the focus of study. The increasing expertise and the specialization of the public role makes their decision-making scope no longer confined to the second type of vaccination, and even extended to the first type of vaccination. So it typically shows the topic of the relationship between expertise and the public decision-making.Through the lens of the sociology of knowledge, this study takes childhood vaccination in Taiyuan city, Shanxi province as a case study, uses the depth interview method, explores the diversity relationship between expertise and the public decision-making in medicine, examines the generation process of expertise and how it plays the role on the public decision-making. Then it reveals that several factors together construct the public decision-making, reflects the diversity feature of the relationship between medicine and the public, science and technology and contemporary Chinese society.According to the different methods of acquiring expertise, expertise is divided into three levels:specialist expertise, interactional expertise, and commonsense expertise. In the light of the type and result of vaccination of the decision-making, the public decision-making of childhood vaccination is divided into three kinds:all vaccination, partial vaccination and rejecting vaccination. In the childhood vaccination, on the one hand, the public with the different level expertise have different decision-making because of the different structure of expertise; on the other hand, due to the effect of other factors and expertise together, the public with the different level expertise tend to do decision-making of the same kind of vaccination.Specially, the groups of specialist expertise include vaccination workers and experts. The specialist expertise of the vaccination workers stems from National Immunization Program system, the practice of vaccination and the cognition of their social role, which makes them not only for their own children do decision-making of all vaccination, but also try to persuade others to do so. Therefore, there is a positive correlation between the specialist expertise and the vaccination workers’ decision-making of vaccination. According to their expertal knowledge, the experts explore the necessity of each vaccination completely from medical principles and respect and observe National Immunization Program system, so they do decision-making of partial vaccination. When directly affected by their particular personal experience, the primal positivism thoughts and the understanding of non-penalty of National Immunization Program system, they reject all of the second type of vaccination and some kinds of the first type of vaccination, even all vaccination.Interactional expertise takes the tacit knowledge as a carrier, and is acquired through the public experience which is not from a field of practice but a product of reading literature and language communication. In the childhood vaccination, the public acquire interactional expertise through individual experience, the Internet, professional books, vaccination certificate, and the interaction with the medical professionals. Because of the different structure of international expertise and being influenced by personal experience, the public do decision-making of accepting all vaccination and partial vaccination. When making the risk-benefit analysis, not fully trusting for National Immunization Planning system and the application of the research achievements, the public will do decision-making of accepting all of the first type of vaccination and rejecting all of the second type of vaccination.The general cognition or experiential judgment on the advantages and disadvantages of vaccination, National immunization program and vaccination risks, has become the background knowledge, which competes and integrates with the public tacit knowledge each other, then forms commonsense expertise that links with local culture and practice. The commonsense expertise goes together with other factors to construct the public decision-making of childhood vaccination. When the public regard National Immunization Planning system as welfare experience, are constructed by vaccination workers’authority, strengthened by personal experience, and guided by herd mentality, they do decision-making of all vaccination for their children. When they both trust for and are restricted by National Immunization Planning system, distrust for and abandon the interaction with the vaccination workers, they make the decision of partial vaccination by virtue of current knowledge and their own experience. When leadingly influenced by social network or restricted by economic factors, they make the decision of accepting all of the first type of vaccination and rejecting all of the second type of vaccination.This paper has found that, first, for the public with interactional expertise, they are willing to acquire more expertise through various ways, and try to make similar decision of vaccination as the expert. However, their aims are not to become or pursue the experts, but to better understand their own daily life and related phenomenon under given cultural framework.Second, making the decision of all vaccination, the public with commonsense expertise still position themselves in passive recipients, are content to obey the image of vaccination workers’authority, and fully enjoy the childhood vaccination as a welfare policy, so they do not think it is necessary to get more information about childhood vaccination through other channels. Making the decision of accepting partial vaccination and rejecting all of the second type of vaccination, the public with commonsense expertise judge the necessity of vaccination by virtue of current knowledge and their own experience, and try to be as participants and users; but they still regard themselves as laymen and do not like increasing expertise which makes them not know how to do the decision-making of vaccination for their own children.Therefore, in the childhood vaccination, one-way linear model of dissemination has been not to adapt to the change of the public expertise, but to reconstruct the pattern of medical knowledge dissemination on the base of different level of the public expertise. Moreover, the departments of management and decision-making should reorient the long-term goal and the short-term goal, re-examine the individual rights and group interests, and transfer the knowledge and information for different groups according to their needs so as to promote the reasonable development and implementation of childhood vaccination policy.