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

By Stephen L. Fielding | Go to book overview

This process of mistakes unfolding is situated within the complex sequence of events creating system accidents. In such a situation, it is difficult for physicians to predict a course of events for a particular patient. Amidst great uncertainty, they must perform procedures that have a slim margin for error.


SUMMARY

Here we have seen that diagnosis and medical treatment are inherently subjective. The majority of malpractice claims involve two types of nonnegligent adverse outcomes. The first involves those cases that are beyond the ability of medical science. Either there are no cures or their treatment outcomes are uncertain. Claims filed on the basis of these outcomes are frivolous from medical and legal points of view. In contrast, a second type of nonnegligent adverse outcome involves system accidents. These can be typified by the statement, "The operation was a great success, but the patient died." System accidents entail the unforeseen interaction of multiple subsystems that result in the failure of the system as a whole--missing the interview after locking yourself out of your apartment and realizing that you let your friend borrow the key that you had hidden in the hall. While claims arising in this category are "illegitimate" because they do not involve negligence, often this is difficult to establish at the outset of these claims. In some cases, these claims may be won by the plaintiff only because they are too costly to defend. These claims illustrate the centrality of uncertainty, since they cannot be clearly understood, sometimes even in retrospect.

We will examine uncertainty more closely in the next chapter in terms of diagnosis and treatment.


NOTES
1.
These scores are based on a scale from 1 to 9 where 1 is emotional trauma only, and 9 is death.
2.
William L. Roper, William Winkenwerder, Glenn M. Hackbarth, and Henry Krakauer, "Effectiveness in Health Care: An Initiative to Evaluate and Improve Medical Practice," New England Journal of Medicine 319, no. 18 ( 1988): 1197-202.
3.
John E. Wennberg and A. M. Gittleson, "Small Area Variations in Health Care Delivery," Science 183 ( 1973): 1102.
4.
James M. Perrin, Charles J. Homer, Donald M. Berwick, et al., "Variations in Rates of Hospitalization of Children in Three Urban Communities," New England Journal of Medicine 320, no. 18 ( 1989): 1183-87.
5.
W. Pete Welch, Mark E. Miller, Gilbert Welch, et al., "Geographic Variation in Expenditures for Physicians' Services in the United States," New England Journal of Medicine 328, no. 9 ( 1993): 621-27.

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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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