Introduction

We begin our chapter with a now commonplace but crucial idea: medicine is a ‘complex’ process involving uncertain parameters, precarious judgements, unpredictable outcomes and limited replicability from case to case (Glouberman and Zimmerman, 2002; Gawande, 2002; Montgomery, 2006; Groopman, 2007; Gawande, 2009; 2011; 2014; 2015; 2018). When viewed from the outside, medicine seems to rely on a sort of diagnostic wizardry concealed within a ‘black box’ (Latour, 1987, pp 2– 3), one that makes possible a vast armamentarium of treatments in an ever more technologically enhanced and, simultaneously, bewildering ecology.1 However, as a growing chorus of experts and many patients have come to realize, medicine remains an ultimately human endeavour, hence imperfect and invariably flawed. In this vein, the erstwhile Oxford University philosophy and politics student turned surgeon, author and global expert on patient safety, Atul Gawande (2009), famously argued: ‘Medicine has become the art of managing extreme complexity – and a test of whether such complexity can, in fact, be humanly mastered’ (p 19).2 And, we would add, medicine is also constantly being tested in terms of its practitioners’ ability to deliver its wares to patients without losing the capacity to treat the human as an individual being with particular needs that exceed the straightforward effort to eliminate disease from the body. In other words, the complexity of medicine is about not just effectively mastering the ever more harrowing accoutrements of technological clinical care but also the irreducible interconnectivity of body, mind and context that make up the human experience of disease and illness (Sacks, 1983; Kleinman, 1988; Mol, 2002).

This chapter opens with a set of questions inspired by Gawande’s observation, one that has catalysed an ongoing dialogue about the uneasy fit between the pursuit of perfection in the medical profession, the imperfect beings who pursue it and the patients who need both curing and caring to navigate their pain, illness and disease. Our work is inflected throughout by more recent trends in medical science and technology that provide context for understanding the dynamic properties of medical practice and the dramatic need for a refashioned paradigm to make sense of its most urgent problems.