Monday, April 9, 2012

Omissions and Social Constructs

In the amended appendix of the second edition of Forgive and Remember, Bosk includes two stories that he had purposefully omitted from the previous edition. Both omissions relate back to the idea of the social construction of medical errors, as he states, “Each blunted the interpretation, analysis, and critique of surgical training and professional socialization, shop-floor ethics, and professional social control embedded in the ethnographic account” (217). These are all very important concepts and the two omitted stories add a great amount of depth to their understanding. The first omission occurs in Chapter 5, where Bosk illustrated the influence attending surgeon’s judgments of the residents’ performance on their careers, exploring the differences between the four types of errors. An entirely new context is added to this chapter because the resident he describes, Dr. Jones, is a woman and not a man as originally stated. Not only was Jones a woman, but she was the sole woman out of all of the residents Bosk observed. Bosk claims that he made this change in order to protect the subjects’ confidentiality and anonymity, but the analysis of the observation changes completely when the gender changes. Jones’ experience as the only woman in a hostile, patriarchal environment may have very well played a huge role in determining her behavior and her subsequent dismissal. The influence that sexism may have had on what others deemed to be her errors is a narrative that encourages a very important discussion regarding male domination, gender identity, and its influence on the medical profession.

The second omission that Bosk made involved the attending surgeon, Dr. Arthur. What Bosk did not mention in the earlier edition was that Dr. Arthur, who believed that residency was a “stress test” and that recreating “battlefield conditions” were critical for developing excellence, would rountinely make incredibly demeaning and racist remarks. This relates to his analysis of the resident Dr. John Carter, who Bosk now believes was baited and ended up leaving the program due to his resistance to the hostile environment created by Dr. Arthur rather than due to his own personal attributes. Both of these omissions are important to Bosk’s work because they add important perspectives to the analysis of medical errors. They add to the discourse as they clearly illustrate how the application of quasi-normative standards can undermine the fairness of the normative standards of medical training. As Bosk states, “We need to ask ourselves: how many voices have we allowed to speak and how many hidden presumptions have we questioned.”

1 comment:

  1. I agree that these omissions are quite interesting, especially the omission of Dr. Jones being a woman. I understand the fact that Bosk was trying to protect her identity by making her a man; however, it seems counterintuitive to showing how social constructs influence error in the surgical field. Being a woman in a male dominated environment would most likely have effects on both how her peers look judge the severity and punishment of her errors. Bosk must have felt some sense that he need to correct his omission when he decided to include the amended appendix in the second edition.