tag:blogger.com,1999:blog-2760353953251845523.post3352676451067104521..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: Gawande Rebuked?Jeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-2760353953251845523.post-92227244493785930912009-09-14T05:53:23.777-04:002009-09-14T05:53:23.777-04:00As an endocrine surgeon at the BWH, Dr. Gawande an...As an endocrine surgeon at the BWH, Dr. Gawande and his colleagues perform hundreds of thyroidectomies and parathyroidectomies yearly. Why don't you ask him why those aren't perfromed at the affiliated BWH-Faukner Community Hospital 5 minutes away for a fraction of the cost. Hippocracy is unflattering.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-23264793190875260412009-07-04T14:57:41.749-04:002009-07-04T14:57:41.749-04:00Atul-
Thanks for stopping by. As a practicing sur...Atul-<br />Thanks for stopping by. As a practicing surgeon, there's no doubt in my mind that your enduring stance on health care reform is far more nuanced than to attribute the problem to one issue (physician financial incentives). <br /><br />I guess I've felt the need to rant about this for the past 2 weeks because of the way I perceive the article has been received by the national media/blogosphere/policy wonks. The purpose of the article, as I understand it, was to highlight the heretofore unacknowledged role physicians play in driving up costs. I'm with you there. In my dissent posts I acknowledge that those MRI's and unnecessary cardiology consults don't happen unless a doctor orders them. But my point is that those overutilizers aren't always driven by revenue considerations. In fact, the things that lead to overutilization (laziness/neglect/fear of not doing enough) are far more nefarious than simple greed. We aren't doing a good enough job, no doubt, but attributing everything to greed misses a more important point; we have to be better doctors. In your commencement address you speak of fighting "for the soul of American medicine". I agree with you; fundamentally we see things similarly.<br /><br />I just got riled up seeing the national media seize upon your piece, not as a focused spotlight illuminating an aspect of the healthcare problem seldom referred to, but as a sole diagnosis and prescription for the entire cost crisis. <br /><br />Anyway, thanks for the response.Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-89519108025003976092009-07-04T14:14:36.403-04:002009-07-04T14:14:36.403-04:00Buckeye,
How much pressure to over treat do you f...Buckeye,<br /><br />How much pressure to over treat do you feel is facility driven? <br /><br />A facility becoming a "_________________ center of excellence" (insert cardiac, ortho, onc, etc.) heavily marketing prospective patients to believe that hi-tech diagnostic/intervention is always best. While in many instances the patient will benefit, these decisions to expand are heavily revenue driven as you all know. How much facility-based pressure is there for MDs to utilize the more pricey route? How do you think the changes to come will impact facilities?<br /><br />-SCNSAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-76313193656634077392009-07-04T11:55:53.925-04:002009-07-04T11:55:53.925-04:00As a Buckeye surgeon myself (I grew up in Athens O...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).<br /><br />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: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html. I don't think we disagree on the fundamentals here. <br /><br />Atulatul gawandehttp://www.gawande.comnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-32189741068428321542009-07-04T09:44:25.124-04:002009-07-04T09:44:25.124-04:00Any Y'all ever take Geography?? I mean a real ...Any Y'all ever take Geography?? I mean a real course, not just memorizing State Capitals like they do in the Pubic School System... Geography drives history...its why America was discovered by Europeans and not Tibetan Monks, Germany invaded Russia, and why you still can't buy Beer in Georgia on Sundays...<br />What Major 3rd World Country is a 6 Peso Cab Ride from McCallen??? <br />Love how the Mayo Clinic's gonna be the model for American Healthcare.... Wow, for your first appointment they bring every specialist to you!!! Bet that's gonna save money...<br /><br />FrankAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-37152241798051950172009-07-03T20:35:34.246-04:002009-07-03T20:35:34.246-04:00How would you respond to the criticism of Gilden&#...How would you respond to the criticism of Gilden's analysis that people are sicker because excessive testing by physicians discover these sick people.<br /><br />The implication is that if Grand Junction's physicians were as "bad" as McAllen's, they too would have all of these sick people to deal with, and costs would skyrocket.<br /><br />I've always been fascinated by how the guidelines for diagnostic testing are set up. You want to catch the diseases, but you don't want to catch so many that the false positive rate becomes significant. So they're, by design, willing to allow some "misses" and allow sick people to go undiagnosed in the name of cost and the adverse effects of false positives.<br /><br />Two of my Aunts (Dad's sisters) have gotten colon cancer. But no colonoscopy for me until age 50 because it's not a first degree relative with the family history. Not even for peace of mind.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-32455798252263170982009-07-03T15:25:55.558-04:002009-07-03T15:25:55.558-04:00AMEN!AMEN!HudsonMDhttps://www.blogger.com/profile/05955328271938173408noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-12504661677942783602009-07-03T12:29:28.082-04:002009-07-03T12:29:28.082-04:00Completely agree that Gawande and the masses of po...Completely agree that Gawande and the masses of politicians who, rather than attempting to understand why the cost is elevated, simply use it as an "aha" moment are missing the boat. I've heard lots of talk in the ORs and hallways of my big academic institution. Most actually decry the movement by Obama and the "culture of money" Gawande describes. Unfortunately physicians are not being asked, unless they wholeheartedly back the president's absurd plan.Resident Anesthesiologist Guy (RAG)https://www.blogger.com/profile/02279676329474145951noreply@blogger.com