Better to Be Lucky Than Good: How Clinicians and Patients Frame Medical Outcomes.

Notions of good or bad luck sit uncomfortably in contemporary medical practice defined by efforts to control life through biomedical knowledge and skilled expertise. Yet, talk about luck is common in healthcare to explain medical courses of action. Framing medical results as fortunate or unfortunate bridges the gap between predicted probabilities and variation in individual cases without undermining scientific neutrality. Luck mediates between the rational ideal of biomedical determinism that does not easily account for variable health outcomes and the magical invocation of faith or fate that denotes a moral judgement. Drawing from ethnographic studies of heart transplantation and fertility medicine, we find that luck is employed as an anticipatory frame to guide decision-making in medicine and as a retroactive frame to justify unlikely outcomes. Invoking luck primes patients for the possibility of a favourable outcome and inserts a positive bias in medical care. The analysis underlines how luck frames in healthcare can shift attention away from structural reasons for disparate outcomes, attempt to absolve healthcare providers of blame from medical errors and promote continuing treatment. These findings indicate that focusing on when healthcare providers and patients invoke luck reveals the scope and limits of medical power and control.