Contexts of Medical Practice

This chapter identifies three dimensions of context that shape how the tension between “practicing money” and “practicing medicine” finds practical expression. In the public context, the private context, and the contexts determined by medical disciplines , the money-means and money-purpose attitudes vary in both presence and form. The private context shows a stronger tendency toward the money-purpose attitude, while the public context is more closely associated with the money-means attitude. Nevertheless, money always plays a role in the public medical sphere as well. Hospital occupancy management, for example, becomes an issue, as hospitals aim to maintain certain bed occupancy rates and set incentives to achieve them. At the level of clinical departments, overtreatment of patients may be used to sustain patient numbers. Disciplines themselves may be divided into three subcategories— high , medium , and low —in terms of their tendency to provide opportunities for medical indications aligned with a money-purpose attitude. In other words, regardless of an individual doctor’s money attitude, the disciplinary context may either restrict or enhance its expression in practice.