Paper short abstract:

Drawing on an ongoing comparative ethnography of hospital cardiology, I examine how physicians negotiate short-term and long-term treatment goals in daily practice.

Paper long abstract:

While the double presence of the future is hardly exclusive to the decision-making environment of medicine, what is distinctive about medical prognosis is that doctors must typically address this double future concurrently because of their mandate to heal. Drawing on a 2-year ongoing comparative ethnography of hospital cardiology, I identify three patterns of what I term "double vision" in cardiology practice: balancing, bridging, and switching. Each pattern of negotiating short-term results and long-term outcomes translates into distinct decisions and decision-making behavior because it is associated with a distinct view of what is at stake--what the problem is. Not surprisingly, therefore, these patterns of medical prospection vary by cardiology subspecialty and, more so, by medical specialty. In fact, especially in the context of cross-functional hospital teams, the negotiation of medical double vision (and the diagnostic and treatment decisions that result from balancing, bridging, or switching between the problematic short- and the long-term future) becomes so tangled that it can only be resolved by relying on organizationally-mandated procedural standards of care rather than professionally-mandated substantive ones.