in Chapter 2. In Chapter 7, possible public policy interventions to deal more effectively with the errors-in-medicine problem by alleviating some of the claimed legal anxieties are outlined.
Closely connected to the problem of medical errors is the substantial difficulty that most physicians experience in dealing with the concepts of medical and legal uncertainty. In every case, "Medical decision making is a probabilistic enterprise," and often decisions must be made and acted upon before the uncertainty can be resolved or even appreciably reduced ( Bosk, 1979, p. 23). Physicians, socialized to expect perfection and wanting to believe that problems all have dichotomous right/wrong answers that they could know if they only had enough information, generally react poorly to the real world of medical gray areas and information voids ( Logan & Scott, 1996; Gerrity, Earp, DeVellis, & Light, 1992; Gerrity, DeVellis, & Earp, 1990).
Similarly, physicians are frustrated because the law, particularly in the malpractice arena with its multiple sources and constant evolution of standards, is often uncertain and ambiguous at any discrete point in time. Physicians want an impossible degree of prospective certainty from the legal system in every conceivable set of circumstances, and they tolerate the gap between expectation and performance poorly ( Morreim, 1990). In the next chapter, I suggest that a fair amount of defensive medical practice that is blamed on fear of litigation and liability is really driven by physicians' uneasy and not always peaceful coexistence with the medical and legal uncertainty that they constantly confront.
This chapter has outlined briefly how physicians generally perceive their legal risks within the current medical malpractice environment that engulfs them, as well as physician attitudes toward law and the legal system more broadly. Many of the perceptions commonly held in this sphere are questionable and even outright erroneous. Nonetheless, perceived legal constraints have always been a much more important force than the truth in shaping actual physician behavior toward patients ( McCrary, Swanson, Perkins, & Winslade, 1992, p. 374). It is to the subject of physician behavior, so motivated and influenced, that I turn in the next chapter.