Gawande Article About Healthcare
I’ve mentioned before my disdain for mainstream science and health reporting. One of the reasons I started blogging to help fill the gap myself is the writings of Atul Gawande. He’s a surgeon who has written two excellent books about medicine: Complications, and Better. Today I noticed an excellent article by Dr Gawande in the New Yorker about healthcare, cost, and the soul of medicine.
Discussion below the fold.
As I’ve said elsewhere, I’m not in medicine for the money. I think that the best doctors aren’t, though admittedly, I’m biased. Gawande seems to feel similarly. Not everyone agrees. As Gawande discusses in this article
…we are witnessing a battle for the soul of American medicine. Somewhere in the United States at this moment, a patient with chest pain, or a tumor, or a cough is seeing a doctor. And the damning question we have to ask is whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.
The article is a discussion of McCallen Texas, which is one of the most expensive healthcare markets in the country. It’s a discussion of why McCallen is so expensive, and how that might tell us how to us reduce healthcare costs without “rationing” healthcare.
I’ll leave you all to read the article rather than summarize it here. Go.
I’ll wait here.
When you’re done keep reading here and I’ll toss out a couple of quick thoughts about the article.
My favorite thing about this article is that Gawande does something only a doctor can: he puts the responsibility back squarely on our shoulders.
It’s true, in the end, most medical decisions that costs alot of money is made by a doctor. Gawande points out that the incentives in the system are set up to favor doctors putting excess cost into the system. In my own meager experience I’ve seen issues with this.
I’ve seen a doctor order X-rays (at 200-400 bucks a pop) to appease a patient rather than spend an extra 10 minutes explaining that it’s unnecessary, and invoking the old CYA, “don’t get sued, just do what the patient demands” argument, just to name one example.
Gawande sees this all as an issue relating to cost control. He points out that healthcare rationing isn’t necessarily the end point to fix our medical system. Rochester, Minnesota is one of the cheapest healthcare markets in America despite being home to the Mayo clinic system. As is pointed out in the article, Mayo’s system is set up to benefit patients. Not hospitals, not physicians checkbooks, not insurance companies.
When incentives are to revenue stream, rather than responsible stewardship, we do not benefit the patients. When we do not benefit our patients, we do not deserve the responsbilities we are granted.
Despite this, in the end this is where I think that responsbility really should lie with doctors. Doctors should be the ones responsible to decide what tests are appropriate. Not insurance companies, not patients. Yet if this is appropriately our responsbility, it’s also our job to steward the system’s resources appropriately.
An attending I worked with recently said “Three things should never be for profit: religion, government, and medicine.” Reasonable people may disagree with that, but not with the statement’s intent. When our incentives force us to be profit minded, rather than patient minded, everyone suffers.