Medical malpractice,social structure,and social control

The origin and handling of doctor-patient conflict can be understood with reference to the sociological aspects of professional health care. This premise is explored by applying Black's theory of social control to the empirical evidence concerning malpractice litigation in the United States. The vertical, organizational, and relational distances between the health care provider and the patient are particularly relevant for predicting when malpractice claims will be made and how they will be resolved. These social-structural variables help explain several patterns in the American malpractice experience, including the aggregate increase in claim rates over the past four decades; the persistence of toleration as the modal response to medical injury; why poorer patients are less suit-prone than higher income patients; why surgical specialties have higher claim rates than general practice and psychiatry; why hospitals are sued disproportionately less often than individual doctors; and the relatively high frequency of prodefendant decisions when lawsuits are decided by a judge or jury.An earlier version of this paper was presented at the annual meeting of the American Sociological Association in Pittsburgh, Pennsylvania, August 1992.