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.
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