Mundane expertise: experiencing the redistribution of expertise in closed-loop brain implants

Scholarship on therapeutic implants has focused on contested forms of expertise, such as audiologists who privilege speech over deaf patients’ social worlds. Less attention has been paid to the mundane, yet consequential, forms of expertise required to implement novel implants in clinical practice, such as encouraging realistic expectations. This US-based ethnographic analysis of continuing care appointments for epilepsy shows how the mundane expertise required to operate closed-loop brain implants – data-intensive devices that detect and interrupt seizures – reshapes how patients perceive expertise and reorganizes the work of care. Due to the multidisciplinary nature and relative novelty of closed-loop implants, follow-up appointments regularly include an engineer from the device manufacturer. Engineers review device recordings and advise clinicians on programming decisions. Patients and caregivers value having access to this additional expert, particularly for questions that sit between medicine and daily life. Yet the engineer’s advisory role also introduces new dynamics. Some patients interpret it as a productive distribution of expertise, while others express lower confidence in their doctor, highlighting how the redistribution of expertise can reshape clinical authority as it is experienced. Further, closed-loop implants require patients to perform daily data work and navigate infrastructural barriers – forms of mundane expertise largely invisible in prior scholarship. Finally, patient satisfaction hinges on medication trajectories and evolving expectations rather than on seizure reduction alone. Together, these findings extend scholarship on innovation and patient experience by demonstrating how mundane expertise is distributed and evaluated in practice and how long-term recalibration shapes the social life of brain implants.