Thursday, April 12, 2012

Social Controls on Medical Doctors

After reading the book Forgive and Remember by Charles L. Bosk, I realized that there are a lot of controls and checks on what goes on in a medical hospital and between all the doctors, attendings, residents, and interns. These controls seemed to be odd to me at firs and I did not know quite how to describe them until recitation today, when we talked about how it seemed a little bit like a cult. I completely agree with this statement because every example that Bosk was giving was about how the interns had to follow around the residents or the attendings, abide by their every word, and check their every move against theirs. There seems to be conformity among them, and although they are learning, the interns never seem to really be doing anything solely on their own. There are always checks and error and guidelines that are very strict that they are expected to follow. In the introduction to hte book as well, Bosk was talking about all the different controls that doctors have on them. For example, there is informal -internal controls, which are the ways members of a group remind each other of their responsibilities during their work routines,  formal-internal controls, which are reviewing performance of a doctor periodically, there are formal-external controls, and so on. There seem to be a lot of controls coming from many different directions on doctors. There is a certain track that the new doctors are supposed to keep on that they cannot deviate from. Additionally, there is much more competition among doctors than in other professions. They are always trying to get on the good side of the higher-ups so they look better and gain favor and a good reputation. I feel that this is because out of medical school all the interns are treated the same and that in order to get even a smidge of appraisal the interns have to go out of their way to mak it known that they did something good or worthy of notice.
All in all, I think there needs to be some reform within the medical field of how things are carried out. I feel that they can reduce the amount of errors that students and interns make by having more guided training, and a lot less hierarchy. The need that interns feel to claw their way to the top probably does not help their concentrationo n their patients. Additionally, I think there needs to be a better way of assigning interns in hte first place. I feel that a lot of the errors they make come from the fact that hey are seeing tons of different patients a day and paper work is being filled out everywhere and it is very disorganized because there are time constraints. Since they do not really know what they are doing I think interns should only focus on a few patients at a time but work with them full out, and work on their charts and paperwork and medications as well. I think that not enough credit is given to them having come out of medical school with that hugh encyclopedia in their head and attendings and residents do not give them the chance to fully show their knowledge. These reforms would most definitely increase the quality of patient care and that is the ultimate goal of health care professionals.

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