Sociology

Forgive and Remember Managing Medical Failure 2nd Edition

An Introduction to Ensuing Discussion
In this study, I intend to devote myself to discussing the medical profession and various related aspects. However, my discussion would not be a lay persons reference to the hallowed medical profession instead, it would be a considered reflection on what two of the best minds in the field have researched, cogitated and written upon, viz. Charles L. Bosk and Talcott Parsons.

The major topics that I shall discuss in the ensuing paragraphs pertain to the peculiar significance of the medical profession to the well-being of society, the growing specialization of medical knowledge and competence, the power that the medical community enjoys in society, the dominant type of the doctor-patient bond, the vulnerability of the patient to the doctors errors, the inevitability of errors in the medical profession as in any other branch of human endeavor, and other associated matters.

Types of Medical Errors Prevalent  
The prevalence of errors in the medical profession is a fact, as it is with any other area of human endeavor. Bosk classifies the medical errors into four categories. According to Bosk, errors could variously be technical, judgmental, normative and quasi-normative.

Judgmental errors or technical errors pertained to the occupational hazard of medical diagnosis going slightly off the mark, or a relatively inefficient prescription. Bosk appears to maintain that errors of a judgmental or technical nature, which are usually admitted, ought to be excused, whereas lapses of a graver normative or quasi-normative variety should be fundamentally abhorrent, unforgivable, and intolerable. Normative errors referred to mistakes wherein a surgeon may be deemed to be guilty of having failed to discharge her solemn duties in a moral, responsible and conscientious manner.

Within the medical field, it seems surgeons are more vulnerable to their errors getting pointed out because they are discernible almost instantly. It would take a doctor more knowledgeable and competent than the one to fault his prescription, but the surgeons error is obvious to even the untutored eye.

Bosks book ought to be of interest to readers beyond the pigeonholes of surgery or medical sociology. The issues of moral discharge of duties in life-saving -- or conversely,  life-imperiling  medical situations, of coordinated teamwork by the subordinates, and of an honest and objective evaluations of the role of everyone involved, cut across disciplines to be of interest to the lay reader as well.

Parsonss Worldview Remains Immensely Relevant
The surgical world can be better understood as a social system in the light of Parsons description of what constitutes a social system (Parsons, The Social System, pp. 1-14, 1951). A social system has a structure and the actors engage in activities that have a meaning in relation to one another. Hence, it is the relational aspect of actions that proves more significant than what the structure consists of per se. The actors in such a system develop their system of expectations that are relative to the various other actors and objects in the situation. Several elements in the situation gradually acquire especial meaning and significance to the various actors for their associated symbolic or indicative values.          

The system of expectations that an actor in a social system harbors motivates the actor to perform actions. Action is usually in response to a stimulus, is governed by the desire for gratification and the fear of deprivation. Besides, there is a definite value-orientation to the actors motivations and actions. Parsons discusses the normative aspect in the actors role-playing at length. He discusses how the evolved culture within a system can be variously transmitted, shared and learned. Bosks analysis of the surgeons role in society and of their normative, cooperative and goal-oriented functioning vividly illustrates just such an integrated and dynamic social system at work.

Parsons Discusses Medical Issues Aptly

Parsons has specifically dealt with the medical profession as a social system (Parsons, The Social System, pp. 288-322, 1951) and his words appear highly insightful and relevant, in the context of the issues of morality, competence and confession that Bosk discusses.

Parsons begins his discussion on the medical system by stressing the importance of the health of the actors, and of freedom from too high an incidence of disease in any system, as being pre-requisites for its effective functioning. Parsons continues his discussion by referring to the preventive role in medicine, beyond its more typical therapeutic aspect. It seems logical that in any system, there can be remedial and deterrent measures, For instance, even with regard to law and order and the crime situation, there is the reaction of arrest and punishment, as well as measures to help prevent the occurrence of crime altogether. A similar preemptive role of medicine perhaps would serve everyone better.

Parsons is aware that the medical profession is a caring profession. However, he observes that the requirements of technical and specialized competence might render the doctor  or surgeon, if we would rather  less than an expert in other areas of competence. The physician is not, by virtue of his modern role, a generalized wise man or sage  though there is considerable folklore to that effect  but a specialist whose superiority to his fellows is confined to the specific sphere of his technical training and experience.  (Parsons, The Social System, p. 292, 1951)

The Custodial Doctor-Patient Relationship
Parsons also discusses the doctor-patient relationship at great length. While discussing other professions and activities, Parsons emphasizes that a person who is ill and in need of treatment is ignorant of the cause of his condition, utterly helpless to improve his lot on his own, and remains unsure of the chances or speed of his recovery.

To the ailing, the doctor appears as the life-saver who is equipped with the specialized, technical knowledge to unravel the disease, as well as the competence to effect its cure. There has been growing specialization in almost every branch of knowledge, including medical science. The medical profession, therefore, is marked by a higher degree of specialization today than ever before.

The greater degree of specialization that doctors manifest these days has a corresponding influence on both the medical profession as well as the doctor-patient relationship. Specialized, professional bodies tend to form an elite club in society that remains devoted and loyal to its members and interests. Doctors have become a powerful lobby today in society.
   
The power that a doctor seems to have for the patient cannot be adequately described. A sick person is apparently at the mercy of how the doctor may heal her back to health, and even snatch a person from the very jaws of death by timely and precise remedies. There is the concomitant risk of the doctor causing exacerbation of a disease or leading to a patients death through negligence or other errors.          
Parsons also reflects on how private practice is getting offset by organizational roles in the medical profession. This demarcates the doctors role from that of the professional who seeks immediate compensation for her services rendered. Parsons discusses the values by which a doctor works in a hospital and the nature of his ethical responsibilities and duties towards a patient in his care. The doctors salary may be independent of how he treats a particular case, but the normative pattern that governs a hospital as a social system inspire him to do his best.

Has the world of doctors and surgeons changed dramatically in recent years or decades It would be difficult to make a well-informed and authoritative assertion on the subject, but the doctor or surgeon today perhaps remains as godlike as ever, attending to lesser mortals in helpless conditions.

The rigid hierarchy in the medical and surgical apparently cannot be replaced altogether, but there is a greater awareness of the issues of moral and responsible choices, the possibility of errors of both the normative or execution nature, and of individual confession and accountability.

By Way of a Conclusion
Both Bosk and Parsons focus on the medical profession. Bosk brings to bear on the subject perceptions and insights drawn from his own experiences and research. Both the writers agree that as a professional community, the doctors are powerful, since they represent the first as well as the last sanction in their area of competence. To reword, a doctor remains both the first appeal and the last resort to a patient. The peculiar nature of a sick persons vulnerability and dependence on the doctors specialized knowledge and efficiency make for a doctor-patient relationship in which the former is by far the dominant partner. Both Bosk and Parsons are concerned with matters of competence, values and accountability in the relation between the doctor  surgeon and the patient. These issues remain of universal and continuing interest and relevance to society.