Sunday, July 5, 2009

Gawande Responds

Atul Gawande paid a visit to this humble blog the other day to respond to some recent posts I've done regarding his notorious expose' piece in the New Yorker on McAllen, Texas. Here's what he wrote:
As a Buckeye surgeon myself (I grew up in Athens OH), I felt I should respond. I don't actually disagree that the story of what causes overutilization is multifactorial, complicated, and bound to vary from community to community. McAllen's has a strong revenue-driven component. Besides payment incentives, habit and fragmentation of care play a role in almost every community, as well. I agree the malpractice system is a mess too and have written and researched at length on this (although it is a much smaller factor -- nowhere with caps or other restrictions have seen lower cost growth).

But I don't think we in medicine acknowledge the revenue-driven component nearly as much as we should. This is a powerful factor. It reinforces leadership that treats medicine as a business. It also discourages leadership to organize care with greater collaboration and time for patients to produce less overtreatment and undertreatment when such work reduces revenues. Reform needs to reward and protect communities that nonetheless achieve success with lower cost and high quality. I gave a lecture recently at greater length on the value of studying and emulating communities that do this differently: I don't think we disagree on the fundamentals here.

See, isn't nice to be able to collegially exchange ideas and thoughts? The internet sure is neato! Atul, as I suspected, realizes that health care reform is an extraordinarily complex endeavour. The McAllen piece highlights one aspect of the problem; i.e. when physicians have too much financial benefit at stake. In that regard, his piece was a masterful strike, a call to arms to look at ourselves, as physicians, in the mirror. The problem is that our Washington DC health care gurus have desperately latched on to this as the be-all end-all of health reform tactics: go after the greedy doctors! Hence my incessant (annoying?) ranting the past few weeks....


Dan said...

Very cool Buckeye.

nemsova said...

The health care debate is far more complex than the pols in washington believe, as both dr gawande and yourself agree. but, buckeye, don't despair--there are millions of health care workers with a heart and soul just like yours, and i believe that most people know that.

sjdmd said...

Crawshaw R: "They All Laughed When I Spoke of Greedy Doctors" [Commentary] West J Med 1985 Feb:142:267

Note the date. The phenomenon is real, I think.

Anonymous said...

is it we in medicine who do not acknowledge the money factor or he in academics who does not acknowledge the money factor?
those of us who sweat payments every month certainly recognize it.
and we did not jump into it, it was thrust upon us by nonphysician insurance companies and medicare payment decisions.