Medical Judgment

Charles L Bosk’s Forgive and Remember: Managing Medical Failure has been an interesting read thus far. As a participant observer of the surgical training program at Pacific Hospital, Bosk provides insight into the ways in which doctors interact with each other, how they cope with the physical and mental difficulties that come along with being a medical professional, and the manners in which they go about teaching their stressful and selective trade to others. He highlights how doctors handle instances in which errors, both large and small, are made.

I am enjoying the different perspective Bosk’s book provides when compared to Groopman’s in How Doctors Think. Bosk is a sociologist and has the perspective of an outsider looking in, whereas Groopman is a doctor and draws primarily from his experience as a medical professional. This is an issue that I think of whenever I read sociological studies, as I am not sure which source provides more accurate information. On one hand, Groopman and others who study and write about their own professions, social positions, nationalities, and other subjects, have lived and breathed their subjects for years if not their entire lives, and therefore may have more information about them. Nevertheless, an outsider has the potential to be more objective about a study, as he or she likely does not have personal or emotional ties to the group and may notice things through observation that someone accustomed to the situation may take for granted.

Bosk’s discussion of how doctors develop and maintain a good reputation ties in well with what we discussed in both classes last week. Bosk’s study is very relevant to the question of how much we can truly trust the decisions made by doctors, as well as the most important attributes we want to see in a good doctor. I was particularly interested in what Bosk says about judgmental errors in his chapter Error, Rank and Responsibility, as the issue of judgment is so incredibly important to anyone in a position to make decisions that affect others. Bosk quotes several doctors who make tough decisions about patients who could be saved by surgeries, though the risks were extremely high. This reminded me of an article that I read for a sociology class on deviance and social control, which I took last semester about a doctor who gave critical patients toxic doses of morphine after Hurricane Katrina in order to allow time for patients who were more likely to survive if they got treatment (Strained By Katrina http://www.nytimes.com/2009/08/30/magazine/30doctors.html?scp=1&sq=strained%20by%20katrina&st=cse). This is obviously an extreme example about which we could discuss the ethical issues for days, but similar to the doctors in Bosk’s book, this doctor made a judgment call and then had to deal with the consequences of that later on. I am excited for the discussion of this book in class, as the example that it provides are much more extreme than those provided by our other readings and I feel many people will have strong opinions on the matter.