‘Telecare’ is an umbrella term referring to the technical devices and professional practices applied in ‘care at a distance’, care that supports chronically ill people living at home.¹ With telecare, the formal or informal carer is not in the same place as the person receiving care. Instead, carers use new communication tools such as webcams, electronic monitors, email and websites to interact with patients, transmit data and provide instruction. Strictly speaking, the telephone is also a distant-care device and it is often central to making telecare practices work. The term telecare, however, commonly refers to thenewtechnical arrangements for...

Theorists of medicine as well as lay people often put healthcare technology, including telecare, in opposition to warm human care and contact. They assume that medical technology is cold, rational and functional, whereas human care is affective and comforting. Where does this opposition of warm and cold care come from? Social theorists often distinguish care from biomedicine and management, presenting the latter as examples of the Habermassian system world. This system world has a logic of instrumentality and threatens to colonise the ‘life world’ characterised by intersubjective relations.¹ Opposing biomedicine and care in the trope of ‘system world conquers life...

The metaphors of warm and cold point to the affective quality of relations between carers, devices and patients, where warm refers to loving, good and well liked, and cold to unfeeling or neutral at best. Metaphors of temperature drag along with them a set of influential yet – in care practice – untenable oppositions, separating the objective from the subjective, the technical from the human, the ethical from the epistemological, and ultimately: the good from the bad. I have suggested a practical aesthetics of fitting as a way to avoid this opposition.

The aesthetic verb ‘fitting’, however, may imply that...

In this chapter, I look at the ways devices and their users solve particular problems together and how, by enacting remedies together,they shape what these problems are. Problems are defined by particular knowledge (e.g. physiology) within which some variables fit (e.g. overactive angiotensin-converting enzymes) and others do not (e.g. trouble getting to the shops). The second problem would be relevant in the clinic and at home, but doctors may or may not translate it in physiological terms. Hence, thetermsdescribing problems and thepracticesin which they are enacted matter to the form a certain problem takes.¹

There...

In the previous chapter, the examples of Mrs Jansen and Mrs Jaspersen and their respective telecare devices showed how they used norms and knowledge from different logics they had to somehow fit together. To the facts, values and directives derived from devices and professionals, both women added their own experiences. By using the webcam, Mrs Jaspersen could develop yet a different kind of knowledge by sharing her concerns about living with COPD with her fellow patients. In this chapter, I look at how people with severe COPD use knowledge in their daily life practices to deal with their disease and...

The previous chapter discussed the important role that webcams play when people with COPD exchange and develop their practical knowledge. The webcam gaveaccessto knowledge and directed people todeveloppractical knowledge together. However, in contrast to the monitoring device in Chapter 4, the webcam did not seem to do much toshape the contentof the exchanged knowledge. Instead of specifically defining, say, deviant measurements as problems to care for, the webcams seemed to leave the definition of problems open to the people using them.¹ The technology was behaving modestly. But just how modest is a webcam?

In...

So far, this book has documented many changes associated with the introduction of telecare, including changes in ideas about good care as well as the problems to target. As discussed before,directivescome with norms and knowledge. Directives give pointers on how to establish a problem and how to look after it best. For example: keep track of your weight (directive) to check if your body is retaining fluid (problem), and if this is the case, the nurse will call you (directive) to intervene quickly (value). Directives become tacit or embodiedroutineswhen people no longer consciously follow them as...

By way of conclusion, this chapter draws out the lessons of my analysis for innovation practices in care and suggests ways to study them and argue about them. The general conclusions about the workings of the telecare practices are embedded in this chapter. The last section entitled ‘Discussions unleashed by an uncontrolled field study’ draws out some general lines on the use of telecare in health care.

Back in the introduction, I described innovation in telecare as a process occurring between the market and the soapbox. The Dutch government’s idea was to place care in a market context where competition...