Conflicted Care

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This compelling ethnography explores how doctors navigate decision-making within the complex environment of a prestigious academic medical center, revealing that patient welfare is often just one of many factors influencing their choices. While the Hippocratic oath emphasizes "do no harm," the realities of hospital settings—characterized by business interests, educational roles, and bureaucratic intricacies—complicate this ideal. Hyeyoung Oh Nelson examines the hidden curriculum of medical practice, shaped by hierarchy, norms for consulting, and regulations governing patient interactions. Physicians frequently grapple with reconciling their commitment to patient care with these conflicting pressures, leading to practices that can inadvertently cause harm. This harm manifests as unnecessary treatments, inadequate pain management, and increased inpatient care costs, which ultimately result in patients delaying or forgoing essential treatments due to high medical bills. Nelson's in-depth study of the Internal Medicine Service unit highlights the shortcomings of current policies aimed at reducing medical costs and offers insightful recommendations for healthcare practitioners, policymakers, and institutions to improve patient care while addressing systemic issues in the medical field.