CONFLICTED CARE: DOCTORS NAVIGATING PATIENT WELFARE, FINANCES, AND LEGAL RISK
Stanford University Press
This book is an ethnographic examination of how Internal Medicine physicians learn to practice medicine on the inpatient wards of a prestigious academic medical center. Central to this learning process is the encountering of a hidden curriculum of doctoring that mirrors the pressures and dilemmas that stem from the commodification, bureaucratization and specialization of the U.S. health care system. I argue that the presence of four highly central, yet contradictory institutional logics—health, market, legal and training—within the hospital creates unique challenges and dilemmas for Internal Medicine physicians as they provide care. These lessons are ones that physicians are not exposed to in their prior medical education and training. Physicians must learn to appropriately navigate these lessons for improper management can jeopardize patient health and well-being, while also resulting in unnecessary financial and legal penalties for the hospital. As they progress through this hidden curriculum, physicians recognize that medical decisions are far more complex than simply following the mandate of “do no harm." Specifically, this book reveals how Internal Medicine physicians capitalize on the moral polysemy of the "health logic" in medicine--drawing on multiple meanings of "health and well-being" to make sense of the clinical decisions they make. This decision-making process is further complicated by the hierarchical dynamics found within the medical profession itself as well as within the structuring of care delivery at elite academic medical institutions.