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. The medical malpractice crisis of the 1980s is given considerable space, as are the various ways in which medical practice has modified itself through such means of self-regulation as risk management and quality assurance. The "astonishing" increase in claims against obstetricians is noted, as is the medical feeling of a "demise of the golden era of trust."
The book's first major section describes obstetrical care in a rural setting in Northern California, with transformation from small general practitioner—owned hospitals to larger nonprofit institutions whose boards of trustees attracted young specialists to the community. Conflict with the new arrivals—young, confident, and to the established general practitioners,