American MedicineThe Quest for Competence

Abstract

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 questions are examined in this book, which fully explores the meaning and politics of competence in modern American medicine. Based on 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—it demonstrates the centrality of the issue of competence throughout the medical world. Competence, the book 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.

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