American Medicine

by Good, Mary-Jo Delvecchio

• ISBN13: 9780520216532
• ISBN10: 0520216539
• Edition: Reprint
• Format: Paperback
• Copyright: 1998-12-01
• Publisher: Univ of California Pr on Demand

Summary

What does it mean to be a good doctor in America today? How do such challenges as new biotechnologies, the threat of malpractice suits, and proposed health-care reform affect physicians' ability to provide quality care? These and many other crucial questions are examined in this book, the first to fully explore the meaning and politics of competence in modern American medicine. Based on Mary-Jo DelVecchio Good's recent ethnographic studies of three distinct medical communities--physicians in rural California, academics and students involved in Harvard Medical School's innovative "New Pathway" curriculum, and oncologists working on breast cancer treatment--the book demonstrates the centrality of the issue of competence throughout the medical world. Competence, it shows, provides the framework for discussing the power struggles between rural general practitioners and specialists, organizational changes in medical education, and the clinical narratives of high-technology oncologists. In their own words, practitioners, students, and academics describe what competence means to them and reveal their frustration with medical-legal institutions, malpractice, and the limitations of peer review and medical training. Timely and provocative, this study is essential reading for medical professionals, academics, anthropologists, and sociologists, as well as health-care policymakers.

Table of Contents

PREFACE TO THE PAPERBACK EDITION	xi	(6)
ACKNOWLEDGMENTS	xvii
Introduction: Engaging the Field	1	(8)
1 Medical Malpractice and the Voices of Medicine	9	(20)
PART I: THE TRANSFORMATION OF THE CULTURE OF COMPETENCE IN RURAL MEDICINE: CONTESTS OF SPECIALTY AND GENDER	29	(92)
Introduction to Part I	29	(4)
2 The Challenge to Local Medicine	33	(21)
3 Competence and Care: Cultural Conflicts Embedded in Gender and Specialty	54	(18)
4 A Crisis of Competence	72	(19)
5 National Crises in Obstetrical Care: Competence and Risk Reexamined	91	(30)
PART II: THE QUEST FOR COMPETENCE THROUGH MEDICAL EDUCATION	121	(50)
Introduction to Part II	121	(4)
6 Narrative Strategies in Presentation and Performance: From Artifice to Competence	125	(18)
7 The Social Production of Physician Competence	143	(28)
PART III: CULTURE, COMPETENCE, AND CLINICAL SCIENCE	171	(38)
Introduction to Part III	171	(6)
8 Competence and Clinical Narratives in Oncology	177	(20)
9 Epilogue: The Relevance of Competence to Policy	197	(12)
NOTES	209	(18)
REFERENCES	227	(22)
INDEX	249