Managing Medical Authority

How Doctors Compete for Status and Create Knowledge

Daniel A. Menchik

• Publisher: Princeton University Press
• Year: 2021
• Print ISBN: 9780691223544, 9780691223568
• eBook ISBN: 9780691223551
• Topic: Social Sciences
• Subtopic: Organisational Behaviour
• Index: Social Sciences

How the authority of medicine is continuously shaped by relationships among physicians, industry, colleagues, and organizations

Exploring how the authority of medicine is controlled, negotiated, and organized, Managing Medical Authority asks: How is knowledge shared throughout the profession? Who makes decisions when your heart malfunctions—physicians, hospital administrators, or private companies who sell pacemakers? How do physicians gain and keep their influence? Arguing that medicine's authority is managed in collegial competition across venues, Daniel Menchik examines the full range of stakeholders driving the direction of the field: medical trainees, clinicians, researchers, administrators, and even the corporations that develop groundbreaking technologies enabling longer and better lives.

Menchik takes us into Superior Hospital to witness surgeries and executive negotiations. He moves outside the hospital to watch professional committees craft standards for treatments, case management, and professional ethics. At industry-sponsored meetings, he observes company representatives who train some experienced doctors on their technologies, while deterring others who they think might injure patients. Using an innovative ethnographic approach tying individual actions and their collective consequences, he considers how stakeholders ally across the various venues of medicine, even as they are sometimes pressed into competition within those venues. Menchik finds that these alliances and rivalries strengthen the authority of medicine as a whole. From place to place, and group to group, we see how a medical specialty renews and reinvigorates itself.

Beginning within the walls of the hospital, and moving to the professional and commercial venues that shape it, Managing Medical Authority offers an agenda-setting take on the social organization of medical authority.

Index

• Abbott, Andrew, 26, 235, 244, 281–82n8
• ablation, 7, 9, 29, 38, 62, 63
• alternatives to, 187, 198, 205, 206, 207
• for atrial fibrillation, 69, 85, 86, 87, 142, 165, 169, 171, 172, 186–87, 206, 222
• defined, 6
• differing methods of, 85–86, 171, 211, 232, 246
• disputed procedures in, 71, 206–11
• economics of, 150–51, 174–75
• radiofrequency system for, 175
• reputational risks of, 151
• surgical risk of, 10
• training in, 45, 140, 164, 166, 169–71, 183, 185, 207–9
• for ventricular tachycardia, 206, 207, 221
• Accreditation Council for Graduate Medical Education (ACGME), 102, 108
• Adler, Mike, 81–82
• “afib” (atrial fibrillation), 69, 71, 142, 164, 168–69, 171, 187, 206, 215, 222
• AIDS, 280n1
• American Association of Medical Colleges (AAMC), 276n16
• American College of Cardiology (ACC), 191, 194–99, 251
• American Medical Association (AMA), 217
• The Anatomy Lesson (Rembrandt), 10
• Andrew (clinician at Medscape conference), 148–49, 150, 159
• Anspach, Renee R., 269n18, 270n28, 271n6
• anticoagulation, 7
• antrum, 172–73, 190, 232, 239
• arrhythmia, 8, 10, 18, 44, 62, 85, 143, 169
• cardiologists’ treatment of, 101, 232
• drugs to ...

Table of contents

• Cover Page
• Title Page
• Copyright
• Dedication
• Contents
• Preface
• Acknowledgments
• One Introduction: Organizing Indeterminacy across Tethered Venues
• Two Superior Hospital’s Inpatient Wards: Grooming Patients and Socializing Trainees
• Three Cardiac Electrophysiologists in the Lab: Achieving Good Hands and Dividing Labor
• Four The Case of the Bed Management Program: Bureaucratic Influences and Professional Reputations
• Interlude Multiple Stakeholders in Nonhospital Venues
• Five Fellows Programs: Maintaining Status, Validating Knowledge, Strengthening Referral Networks, and Supporting Peers
• Six Physicians and Medical Technology Companies at Hands-on Meetings: Strengthening the Occupational Project
• Seven The International Annual Meeting: Global-Local Feedback, and Setting Standards for Problems and Solutions
• Eight Conclusion: Managing Medicine’s Authority into the Future
• Appendix Methods
• Notes
• Works Cited
• Index