The Practice of Uncertainty: Voices of Physicians and Patients in Medical Malpractice Claims

By Stephen L. Fielding | Go to book overview

FOREWORD

The malpractice problem counts as one item on the list of reasons why U.S. health care is unique. From an international perspective, no other country has experienced the raw and dispiriting processes that Stephen Fielding documents in this pathbreaking book. All other countries, whether economically developed or less developed, have either worked out arbitration systems to prevent the adversarial approach adopted in the United States, or have not moved nearly so far along the path of litigation as a way to deal with the inevitability of medical mistakes. Along with the lack of universal access provided through a national health care program, the enormously high proportion of gross domestic product devoted to health care (approaching 15 percent), the proportion of health care expenditures devoted to administration as opposed to clinical services (about 25 percent), and the unprecedented corporatization of care (for instance, nearly 80 percent of insured U.S. citizens covered by managed care, and not a single not-for-profit managed care organization founded since 1989), the malpractice problem distinguishes our health care system from those of all other societies.

Fielding goes further than prior researchers in detailing the anguishing processes of distrust and recrimination that have come to typify medicine in the United States. While several important studies of malpractice have appeared during the 1990s, they have focused on the statistical frequency and predictors of medical errors and subsequent lawsuits, rather than

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The Practice of Uncertainty: Voices of Physicians and Patients in Medical Malpractice Claims
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Illustrations ix
  • Foreword xi
  • Preface and Acknowledgments xv
  • People Interviewed xvii
  • Notes xxiii
  • 1 - Historical and Social Background 1
  • 2 - Setting the Contemporary Stage 25
  • Notes 43
  • 3 - System Accidents 49
  • Notes 66
  • 4 - Uncertainty -- Which Diagnosis and Treatment? 69
  • Summary 81
  • 5 - We Were Going to Be Society's Heroes 83
  • Summary and Discussion 98
  • 6 - Am I the Same? 103
  • 7 - Gender and Telling the Story 123
  • Summary 144
  • 8 - The Defense of Wealth 147
  • Notes 168
  • 9 - Implications 171
  • Notes 196
  • Appendix - Theory and Method 199
  • Notes 208
  • Bibliography 211
  • Index 225
  • About the Author 231
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