ABSTRACT
This chapter places hospital care in its social context among the health care system, the medical profession, and the hospital organization. Health care is conceptualized as a system that addresses the problem of mental and physical illness and operates based on communication about disease. The chapter further explains how this function is dealt with by the medical profession and their interactions with patients. Central to the doctor–patient relationship is that medical treatment is characterized by a “technology deficit,” meaning that the identification of causal factors and the predictability of the results in health care are marred with uncertainty, which leads to a certain amount of structurally inevitable failure. Therefore, physicians often follow a case-based logic and exhibit a decision-making process predicated on ad hoc premises and individual judgment. Consequently, physicians lay claim to a high degree of autonomy in their work, making organizational control of professional decisions particularly challenging. Finally, hospitals are conceptualized as decision-based systems structured by decision premises, whose performance is subject to internal and external judgments based on comparisons.
