Stretching out and expanding work practices in time and space: The case of telemedicine

The article utilizes the imagery of stretching out and expanding for exploring what happens when medical practices and health working arrangements are temporally and spatially reconfigured. Based on the tenets of contemporary practice theory, and on the back of a three years' longitudinal study of telemedicine in northern Italy, the article investigates some of the practical issues raised by the subversion of the proximity principles that still underscore most current medical practices. The study argues that in order to cope with the expansion of their activity practitioners had to face three main practical problems: they had to redistribute their work and tasks among human and non-human elements, they had to reframe the ways in which the activity was made accountable, and they had to reconfigure the relationships between all those involved. The stretching out and expanding of medical practices in space and time implies thus much more than a simple redistribution of what was already there and it triggers profound changes which included the reframing of the object and content of the activity, the emergence of new artefacts and new identities, and the modification of the geography of the power positions between all those involved.