This process of mistakes unfolding is situated within the complex sequence of events creating system accidents. In such a situation, it is difficult for physicians to predict a course of events for a particular patient. Amidst great uncertainty, they must perform procedures that have a slim margin for error.
Here we have seen that diagnosis and medical treatment are inherently subjective. The majority of malpractice claims involve two types of nonnegligent adverse outcomes. The first involves those cases that are beyond the ability of medical science. Either there are no cures or their treatment outcomes are uncertain. Claims filed on the basis of these outcomes are frivolous from medical and legal points of view. In contrast, a second type of nonnegligent adverse outcome involves system accidents. These can be typified by the statement, "The operation was a great success, but the patient died." System accidents entail the unforeseen interaction of multiple subsystems that result in the failure of the system as a whole--missing the interview after locking yourself out of your apartment and realizing that you let your friend borrow the key that you had hidden in the hall. While claims arising in this category are "illegitimate" because they do not involve negligence, often this is difficult to establish at the outset of these claims. In some cases, these claims may be won by the plaintiff only because they are too costly to defend. These claims illustrate the centrality of uncertainty, since they cannot be clearly understood, sometimes even in retrospect.
We will examine uncertainty more closely in the next chapter in terms of diagnosis and treatment.