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Incorporating in-depth interviews, statistical data, and prior studies, Fielding illustrates how modern medicine is a victim of its own success. The historical record since the early 19th century shows that the rate of malpractice claims has increased as medicine developed new and more complex procedures. Fielding integrates macro- and micro-levels of analysis to explain how scientific medicine is inherently prone to adverse outcomes no matter how competent medical provides are and how patients often feel their personal experiences and views are marginalized during the course of their medical care. This combination makes it more likely that patients will sue when something goes wrong.
The so-called medical practice crisis is mostly the result of a system of health care that has promoted professional dominance and high-tech care. This system both shapes and is shaped by the daily clinical context in which patients, physicians, and other providers interact. The key policy implication would be to place greater emphasis on primary care and prevention rather than curative or high-tech interventions. For example, aggressive programs to ensure primary care for all, public health, occupational health, and accident reduction would go a long way to improve both the health of the population and reduce the rate of medical malpractice claims.
List of contents
Foreword
Preface
People Interviewed
Historical and Social Background
Setting the Contemporary Stage
System Accidents
Uncertainty--Which Diagnosis and Treatment?
We Were Going to be Society's Heroes
Am I the Same?
Gender and Telling the Story
The Defense of Wealth
Implications
Afterword: The Limitations of Science and Technology
Appendix: Theory and Method
Bibliography
Index
About the author
STEPHEN L. FIELDING is Research Assistant Professor in the Department of Family Medicine at the University of Rochester School of Medicine and Dentistry where he is managing several research projects on women's reproductive health./e In addition to conducting his work on medical malpractice, he spent a year at the Harvard School of Public Health in 1988, where he worked on a major study of patients' socioeconomic status and hospitalization. From 1990 to 1991 he conducted research at Brandeis University on emergency room utilization in Indonesia, and taught at the State University of New York at Geneseo from 1991 to 1997.
