SETTING THE CONTEMPORARY STAGE
We implicitly think that malpractice claims arise solely from what physicians did or did not do. Certainly the medical treatment rendered by a provider can be an immediate cause of an adverse outcome, but the performance of physicians must be viewed within the wider social, organizational, and political contexts in which they practice. At the structural level, the American health care system makes physicians the targets for claims because the complexity of this system increases the chances that something will go wrong despite the efforts of even the best-trained practitioners. Today, physicians practice under ever more complex circumstances. Furthermore, medicine has become an industry, the result of numerous power centers guided by a capitalist class and operated increasingly for profit, often leaving both physicians and patients feeling isolated and dehumanized. 1
This chapter examines how each of the structural level factors (shown in Figure 1.1 of Chapter 1) contribute to malpractice claims. My purpose is to show the complexity surrounding these claims--that they are not necessarily the result of incompetent physicians or greedy patients.
The medical-industrial complex emerged along several dimensions and transformed medical practice into a highly structured institution