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

By Stephen L. Fielding | Go to book overview

cancer, there was greater certainty--patients would die or go into remission. Unfortunately, the more we "progress," the more we must accept the uncertainty that is inherent to modern medical treatment. Indeed, uncertainty seems to be built into nature itself. As Einstein considered, but could not accept, God does play dice with the universe.


SUMMARY

The selection of treatment is related to the standard of care. This standard is the criterion related to what is considered generally accepted medical practice on a regional or even national basis. The standard of care is not absolute but, rather, one that physicians have collectively agreed upon. Even to the extent that physicians are well-trained, alert, and adhere to the standard of care, this does not always guarantee that they will not harm the patient, nor even that they did the "right" thing, in retrospect. Medical uncertainty arises for three reasons: a lack of knowledge or understanding on the part of a specific individual, a lack of knowledge or understanding on the part of medicine itself, and the uncertainty associated with which of several possible treatments to employ. The third aspect of uncertainty is related to the huge expansion of medical knowledge since the 1950s and the proliferation of diagnostic technologies that overload physicians with information and possible alternatives. Physicians often have to analyze a huge amount of diagnostic information and select treatment from a range of options, often within a short period. Thus as medicine "progresses," the nature of uncertainty changes from understanding too little to understanding too much.

In the next chapter we will examine how the physicians and claimants I interviewed retrospectively defined their clinical context.


NOTES
1.
Ray Fish and Melvin Ehrhardt, "The Standard of Care," Journal of Emergency Medicine 12 ( 1994): 545-52.
2.
Stanley W. Hatch, "Clinicolegal Aspects of Practice Guidelines for Pediatric Eye and Vision Examination," Journal of the American Optometric Association 66 ( 1995): 501-9.
3.
Renée C. Fox, "Training for Uncertainty," in The Student Physician, ed. Robert K. Merton, G. Reader, and P. L. Kendall, 207-41 ( Cambridge, Mass.: Harvard University Press, 1957).
4.
Renée C. Fox, "The Evolution of Medical Uncertainty," Milbank Memorial Fund Quarterly/Health and Society 58, no. 1 ( 1980): 1-49.
5.
Martha S. Gerrity, Jo Anne L. Earp, Robert F. DeVellis, and Donald W. Light , "Uncertainty and Professional Work: Perceptions of Physicians in Clinical Practice," American Journal of Sociology 97, no. 4 ( 1992): 1022-51.
3.
Timothy Marjoribanks, Mary-Jo DelVecchio Good, Anne G. Lawthers, and

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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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