Digital hospital and medical professionalism of physicians

From the industrialization efforts that started with mechanical weaving in the 18th century to the present day, dizzying developments have been experienced in technology and still continue to be experienced. At the point reached today, interconnected processes are in communication, objects communicating over the internet collect data and completely change the production process, came into prominence interaction between machines and individuals, IV. The Industrial Revolution (Industry 4.0) is happening. Industry 4.0, where there are simultaneous advances in many fields from gene sequencing to nanotechnology, makes it possible for these technologies to intertwine and interact in physical, digital and biological fields. Therefore, with the technologies that are at the base of all industrial revolutions and their transfer to production processes, production relations are transformed. As a matter of fact, due to the competitive pressure created by the capitalist production relations, technological developments are being applied to the production processes more and more. As such, the social conditions determined by the production relations of the society affect health and health services, and as the social conditions change in the historical process, health and health services also change. Since the end of the 17th century, thanks to the fact that the labor force was available in a "useful" condition after the Industrial Revolution, the institutionalization and centralization of medicine from the 18th century, the foundations of health systems were laid with social security in the 19th century, and scientific developments in medicine led to the "marketization of medicine/health" the relationship between capitalism and health has come up to the 20th century with a historical process. In the developing process, the globalization of capitalism, the reshaping of the state with a neoliberal understanding have been effective in the marketization of health services. Therefore, the dominant ideology that determines the social conditions not only determines the concepts of health and disease, but also shapes the service, profession and division of labor. Thus, the profession of medicine; although it has a traditional and conservative appearance, it rapidly evolves to be redefined in a practical and conceptual framework with the guidance of these factors and is re-established by technology. As a matter of fact, with the effect of neoliberal practices implemented together with the Health Transformation Program at the beginning of the 2000s, physicians began to lose their status as a result of the restriction of their professional autonomy and acting according to market rules. On the other hand, the legitimacy of the developments produced by the transformation/transformations experienced through Information and Communication Technologies (ICT) in the digital hospital has the potential to produce some controversial dynamics (such as the risk of commodification of information/data, violations of privacy, new surveillance and control practices, restriction of professional autonomy). In this context, the practical and ontological transformation of the medical profession cannot be independent of the ongoing Industry 4.0 discussions. As such, this study focuses on the problem of how physicians' working lives are transformed depending on Industry 4.0 technology. The main purpose of this study is to examine the transformation that digital hospitals will create / create in the production of health services (depending on the articulation of technological developments with neoliberal policies) through the processes and dynamics inherent in the profession of medicine and the medical professionalism of physicians. For this purpose, this research, which was designed in a qualitative research design, was carried out in Tire State Hospital, which is the first digital hospital in Turkey to receive the title of "Level 7". Data were collected through in-depth interviews with 31 participating physicians between 11 November 2019 - 21 November 2019. As a result; the labor of physicians with the effect of both technologies (ICT, information systems, medical technologies) and neoliberal policies; It can be stated that its transformation into a commodity, the change in its meaning and the decrease in its value, cause the physicians' mastery knowledge, professionalism, conflict against technology, and transformation of their professional skills.