As we have seen, medical malpractice involves much more than an isolated act of negligence that causes a patient injury or loss of life. To better understand why structural factors contribute to adverse outcomes, this chapter describes three levels of medical care and their relationships to diagnosis and medical outcomes. Medicine has long touted itself as a science, but in reality it is more an art. How a physician arrives at a diagnosis and attempts to treat disease is as varied as the number of practitioners, and it involves more subjectivity than most people realize. The increasing use of high-technology medical interventions has become the norm in today's medical arena. It is, however, not without its problems, and we will see how the advantages of intensive technology use are offset with disadvantages. This chapter also discusses how adverse outcomes can result from "system accidents"--failures that happen even under the best of circumstances. Briefcase studies illustrate how treatment can lead to adverse outcomes. Most of these cases come from my own research; one case comes from the medical literature.
There are three levels of medical care: primary, secondary, and tertiary. Primary medical care involves routine diagnostic and therapeutic procedures related to illness prevention and treatment of common health