We are at a cusp point in medical generations. The doctors of former generations lament what medicine has become. If they could start over, the surveys tell us, they wouldn’t choose the profession today. They recall a simpler past without insurance-company hassles, government regulations, malpractice litigation, not to mention nurses and doctors bearing tattoos and talking of wanting “balance” in their lives. These are not the cause of their unease, however. They are symptoms of a deeper condition—which is the reality that medicine’s complexity has exceeded our individual capabilities as doctors.
Gawande has two main arguments. First, that when doctors use checklists they prevent errors and quality of care goes way up. Second, that doctors need to stop acting like autonomous problem solvers and see themselves as a member of a tight-knit team. Gawande is one of the few sane voices in the health care debate. However, later on in his speech, he says that the solution to the health care conundrum is not technology. To a large degree, I agree with him. But not completely. Tech still has a big role to play. If we take a closer look at Dune and Star Trek, we’ll see why Qualcomm and the X-Prize Foundation are ponying up 10 million bucks to fund a piece of medical technology that could help make Gawande’s dream of team-based medicine a bit closer to becoming reality. Read More
Did anyone out there raise their hand? If you did, I congratulate you. But, if you’re like me, a list of minor malfunctions and maladies that you’d love to fix popped up in your head. None of us are perfect, there is always something to improve. We are, after all, only human. And most of us would jump at a chance to improve some of those little issues.
The last time I went to the doctor’s office, the nurse who took my vitals said, “What are you doing here? You’re as healthy as they come!” That can hardly be true. I eat street-vendor food more often than I go to the gym. How can I be a picture of health? The fact is, I’m not. Just because I’m not ill (save the sniffles from the end of a cold) and not injured, doesn’t mean that I am, by default, as healthy as I could be.
For some bizarre reason, we don’t think about our bodies that way when it comes to health care and self improvement. We don’t pursue excellent health the way we strive to be better in our hobbies and work. So, where did we get the idea that mediocre health is good enough?
Doctors are not doing so well. In addition to being extremely expensive to train, maintain, and, of course, to visit, they have a lot of other problems. If your doctor is a drunk, an addict, or just plain-old incompetent, his or her colleagues may not tell you or anyone else. Even when doctors are sober and sharp, their diagnoses are often, ahem, less than correct. Mark Walker’s “Uninsured, Heal Thyself” paints a pretty terrifying picture:
Physicians can and do misdiagnose frequently: they prescribe for nonexistent diseases or injuries and fail to notice symptoms or make the correct inferences. An article in the Journal of the American Medical Association noted: “Two 1998 studies validate the continued truth that there is an approximately 40% discordance between what clinical physicians diagnose as causes of death antemortem and what the postmortem diagnoses are” (Lunberg, 1998). This is a pretty shocking statistic: in 4 out of 10 deaths there is a disagreement between what physicians think is the cause of death prior to autopsy, and autopsy findings.
Egads. Is there any solution to the doctor debacle? Read More