THE SOCIAL CONTROL OF MEDICAL MISTAKES

How doctors police mistakes among themselves varies. Physicians support, tolerate, avoid, ridicule, confront, report, and banish colleagues for errors. What explains this variation? Drawing on semi-structured interviews with 43 clinicians from two academic health systems, I find that the “social geometry” of medical cases partially explains and predicts the reactive handling and proactive elimination of errors in healthcare. In Chapter 1, I review the literature on medical mistakes, including their prevalence and handling, and introduce the logic of social geometry, an innovative sociological paradigm developed by Donald Black that explains behavior with its location, direction, distance, and movement in social space. In Chapters 2 through 4, I demonstrate how geometrical theory orders the physician self-policing of errors. Specifically, in Chapter 2, I argue that assertive and passive responses to mistakes (e.g., direct talking-tos and toleration) are partially explained by the vertical direction of medical cases. Similarly, in Chapter 3, I argue that antagonistic and sympathetic responses (e.g., gossip and consolation) are partially explained by the social distance of medical cases. In Chapter 4, I turn my attention to the prevention of mistakes. I find that doctors use a number of individual strategies to curb errors, including avoidance, permitted mistakes, and emotional control. Preliminary evidence also suggests that errors are successfully prevented when multiple experienced doctors quickly respond to injury and illness, which tends to arise under a particular case-level social geometry: notably, when patients are intimate with their doctors and have high social status. In Chapter 5, I end by discussing the implications of this research, and demonstrate how it can inform the effective engineering of “just cultures” in healthcare.