THE UNKINDEST CUT by Marcia Millman


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Despite the demeaning title, this level-headed study of surgical practices explores conflict and competition within the hospital staff and criticizes the faulty accountability policy for medical mistakes. No gift for recuperative patients and no treat for surgeons, it profiles several prima donnas in the OR and offers the paradox that doctors want full control without full responsibility. Millman is aware of the convergences--medical centralization, prepaid health plans--that have limited the automony of private doctors, and she is alert to the political nuances and personality quirks that attend standard operating procedures. She finds that medical lapses, rarely acknowledged, come with strong professional and institutional supports for avoiding guilt; although some few deceptions are criminal, more often they are grossly insensitive, manipulating, and even blaming the patient for the physician's error. Professional regulation of questionable or unethical practice is not restricted to physicians--teachers, lawyers, and policemen have similar organizations--but clearly some other means of monitoring treatment is in order. Millman's concluding suggestion-a discontinuation of the system as a profitmaking enterprise--won't win friends at the AMA and does not really deal with the egoistic aspects of the problem. A readable, perceptive examination of the tensions and politics of health care without accusatory rhetoric or excessive bloodletting.

Pub Date: Jan. 1st, 1976
Publisher: Morrow