tag:blogger.com,1999:blog-2760353953251845523.post3791305785408075170..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: Gawande ReduxJeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-2760353953251845523.post-63452741426626993942009-06-27T09:46:37.095-04:002009-06-27T09:46:37.095-04:00Dan-
There's a disconnect between the exposito...Dan-<br />There's a disconnect between the expository excellence of Gawande's piece and the conclusions he makes. No one is denying that physicians overutilize. The question is why. And my point is that attributing everything to mere "physician greed" is a deductive leap, at best. The motivations are far more complex. <br /><br />Read the article again. I've read it five times. He zeroes in on this "culture of money" that infects McAllen, exemplified by strip mall owning docs who also run their own surgicenters. The data he supplies confirms that McAllen spends more than everyone else. But he never proves motivation. And how can you? All you can do is posit a reasonable guess. Financial motives certainly play a role but, my god, the waste I see in practice generally has little to do with docs working the system to pad their bottom line; mainly it's docs not thinking clinical decisions all the way through, docs being disconnected from any sense of the cost of medicine, and even docs being lazy. <br /><br />Incentivize phyisians to be able to spend adequate time with their patients (rather than shotgun consulting half the sepcialists in the hospital). Fix malpractice. Inculcate in younger doctors an awareness of the cost factors in clinical decision making. <br /><br />The Gawande article doesn't lend credence to these factors. By oversimplifying the problem, it just provides ammunition to healthcare wonks to say that we need to reduce physician payouts and disallow any medically-related entrepreneurial activities. That's why you see Obama quoting from it every other press conference. <br /><br />Youre right about bringing a knife to a gunfight though. I have no chance against the literary, NewYorker-writing, Harvard surgeon. The article has already achieved mythical status. But someone has to dissent; might as well be a random, irrelevant gen surgeon in Cleveland, right?Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-36156011311433926892009-06-26T23:06:47.770-04:002009-06-26T23:06:47.770-04:00I understand where you're coming from, but arg...I understand where you're coming from, but arguing against a very well researched and cited argument like Gawande's with this post (and your last) is sort of like bringing a knife to a gun fight. <br /><br />I think that Dr. Gawande makes a strong case that is consistent with what we know about the effects of perverse incentives on people (bankers and doctors alike).<br /><br />I know I've worked with physicians that when I told them a patient had an occluded femoral artery the question I got was "Can you check the system and see if he has insurance?" I'm glad you're not one of them, but in the large hospital I worked there was probably a 50/50 split of doctors that were there for patients versus doctors there for money. <br /><br />Fixing the incentives is a solid start, it doesn't have to be the end.Danhttps://www.blogger.com/profile/02128499858806569768noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-77114181580792019282009-06-26T20:57:12.514-04:002009-06-26T20:57:12.514-04:00Well said, sir, well said.Well said, sir, well said.Anonymousnoreply@blogger.com