Required Reading: "Lessons of a $618,616 Death"

Rather than discuss this at length, I'd like to use this Friday to just present Business Week's cover article titled "Lessons of a $618,616 Death" by Amanda Bennett. It's a personal story, and to me with its simplicity and candor stacks up with the best non-fiction short stories. The article's straightforward questioning of health care reminds me of the best of Atul Gawande. Its breakdown of the facts and figures of the charges, bills, and insurance coverage strikes me as the best anecdotal analysis I've seen of where our health care system currently stands.

Better by Atul Gawande: Chapter 6

The focus of this chapter, titled "Piecework," is on doctors' pay and its inevitable connection to the health insurance industry. Gawande develops his thoughts on health insurance further in his New Yorker article on health care costs which was published this summer. Doctors' pay is also informed to some degree by the malpractice lawsuits they face, the subject of the previous chapter.

Better by Atul Gawande: Chapter 5

Titled "What Doctors Owe," the fifth chapter of Better continues the discussion of doing right and focuses on malpractice lawsuits.

Better by Atul Gawande: Chapter 4

The fourth chapter of Atul Gawande's Better moves the book into its second section, titled "Doing Right." This is one of three core challenges Gawande laid out in the book's introduction and which we briefly touched upon in one of our earlier discussions. The chapter is titled "Naked" and concerns the exam room etiquette that doctors and patients expect from one another and often uncomfortably tiptoe around.

Better by Atul Gawande: Chapter 3

To continue the chapter-by-chapter discussion of Better by Atul Gawande, here's a quick overview of Chapter 3: Casualties of War. It covers the efforts of battlefield surgeons in Iraq and Afghanistan to save as many wounded in the wars as possible.

Better by Atul Gawande: Chapter 2

It has been over 2 months since my chapter 1 recap of Atul Gawande's Better. I've delivered very little after chapter 1 and Gawande's bio discusssion a while back. Despite my lack of activity, I have been progressing and feel the book is important enough to continue discussing.

Chapter 2 is titled "Mop-Up" and covers the World Health Organization's efforts to minimize the spread of a polio outbreak in India a few years ago.

Better by Atul Gawande: Chapter 1

I had originally tried to combine the intro and chapter 1 of Atul Gawande's Better, but chapter 1 actually had some of the most profound "wow" moments in the book. The focus is on hand washing, in the context of diligence in the pursuit of excellence. The basic problem is this: doctors don't wash their hands enough, so how do we get them to do it? Much like Starbucks' solution to not wasting milk was pioneered by one of its in-store baristas rather than management, the most effective tactic for hand washing was to outsource the solution to the employees of the hospitals.

Better by Atul Gawande: Intro and Chapter 1

To begin our discussion of Better, by author and surgeon Atul Gawande, I want to begin with Gawande's bio and a review of his article on health care reform

Better by Atul Gawande

I'm trying something new - I am about to begin reading Better: A Surgeon's Notes on Performance by Atul Gawande. Gawande is also the author of the New Yorker article on health care costs we discussed a few weeks ago. I want to post updates after each chapter, feel free to read along with me if you like. The intro will be discussed next week.

Health care reform

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/08/AR2009070802023.html

My take from both articles is that there is a very large concern that doctors are ordering too many tests [or operations]. But being the naive optimist that I am, I am inclined to think they are ordering the tests to protect themselves from the threat of malpractice, rather than ordering tests purely for profit. The mindset would be that ordering an extra test may reveal the 1% of cases where there exists a problem and not ordering the test increases the odds of malpractice by 1%, so a doctor will play it safe and order the test. These additional tests/procedures/operations may be easier and more expensive than a more difficult but less expensive recommendation. (Gastric bypass surgery is easier and more expensive than trying to get a fat person to go on a diet and lose 50 pounds, the harder/cheaper option)

I think this is a huge challenge, because it requires changing the mindset of all doctors out there. The examples presented make it seem that collaboration among doctors may be the single best way for doctors to be comfortable ordering fewer tests. (Both at the Mayo Clinic and the community in Colorado).

So the big question is: How do you make doctors want to collaborate and share information/training/

experience/knowledge? I think that is the way to keep costs down. An individual doctor will never see every situation, but if he can ask 100 other doctors about a case and whether he should order a test, he may get enough responses from other doctors who have seen the same symptoms and be able to provide a clue or indicator as to why he shouldn't order the test.

Electronic records is a big step in the right direction.