“Vertical Direction and the Social Control of Medical Mistakes”

How doctors police mistakes among themselves varies. Physicians support, tolerate, avoid, ridicule, confront, report, and banish colleagues for errors. What explains this variation? An established theory of social control and a growing literature on stratification in medical education suggest that the vertical direction of medical cases may partially account for the different social control strategies physicians use to manage mistakes. Drawing on semi-structured interviews with forty-three clinicians from two academic health systems, I find that forceful and overt strategies (e.g., appeals to authority) are more likely to occur in an upward direction than a downward direction, by lower-status physicians in response to mistakes made by higher-status physicians.