What does it mean to be a good doctor in America today? How do such challenges as new biotechnologies, the threat of malpractice suits, and proposed health-care reform affect physicians' ability to provide quality care?

These and many other crucial questions are examined in this book, the first to fully explore the meaning and politics of competence in modern American medicine. Based on Mary-Jo DelVecchio Good's recent ethnographic studies of three distinct medical communities—physicians in rural California, academics and students involved in Harvard Medical School's innovative "New Pathway" curriculum, and oncologists working on breast cancer treatment—the book demonstrates the centrality of the issue of competence throughout the medical world. Competence, it shows, provides the framework for discussing the power struggles between rural general practitioners and specialists, organizational changes in medical education, and the clinical narratives of high-technology oncologists. In their own words, practitioners, students, and academics describe what competence means to them and reveal their frustration with medical-legal institutions, malpractice, and the limitations of peer review and medical training.

Timely and provocative, this study is essential reading for medical professionals, academics, anthropologists, and sociologists, as well as health-care policymakers.

Mary-Jo DelVecchio Good is Professor of Medical Sociology at Harvard Medical School, coeditor of Pain as Human Experience: An Anthropological Perspective (California, 1992), and coeditor-in-chief of Culture, Medicine and Psychiatry: An International Journal of Comparative Cross-Cultural Research.

"With uncommon intellectual breadth and an equally rare ability to pare down to the essentials of 'what we care about' . . . Good has also contributed to an informed anthropology of American biomedicine."—Sue Estroff, American Ethnologist

"Thought provoking and revealing in its exploration of the issues which surround the core of what it means to be a competent physician in America."—Dawn E. DeWitt, Journal of General Internal Medicine

"Good’s work is securely anchored in the tradition of medical sociology. . . . Each of the three ethnographies has discoveries and telling themes that will engage diverse readers interested in health, medicine, and/or social science. . . . Good successfully contributes to our understanding of the culture of medicine. She succeeds beyond her stated purpose, and while the theme of competence may have piqued her early interest and may serve as a thread to explain the presence together of these three ethnographies, her work is broader and richer than the theme she sets out to explicate." --Claire Kohrman, Contemporary Sociology

"This ethnographic study deals with several aspects of competence within the culture of American medicine. There is emphasis on the impacts of various ways in which ‘competence’ is interpreted not only by various branches of the profession, but also by other professions such as law. . . . A valuable contribution to social research that could help us as physicians understand ourselves a little better." --Andrew D. Hunt, Journal of the American Medical Association

"Good uses competence as a paradigm to study the knowledge, skills, judgment, power, and moral character of the medical profession. . . . Although we have the most sophisticated and advanced system of medicine in the world, those in the profession continue to grapple with who and what they are. The careful descriptions of medical ethnography can serve as a rich way to explore the evolution of competence in health care. American Medicine will be of interest to policy makers, educators, sociologists, and physicians, or students in search of greater insight into the practice of medicine." --Michael Grodin, New England Journal of Medicine