Three medical specialties are examined in this study: obstetrics, thoracic surgery, and general pediatrics. The findings reveal three features of medical practice. First, physicians distinguish technical from clinical autonomy. Second, cost containment reduces the clinical autonomy of physicians by pressuring them to utilize fewer resources. Third, the threat of being sued reduces clinical autonomy since physicians feel the need to run more diagnostic procedures and manage care differently. Malpractice suits and cost containment are discussed as potential forces for change away from the dominant medical model of health care.
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