Anyone who cares in the least about a loved one, or their own well-being, must ... MUST!!!!!!!!!!!! ... read/absorb/inhale Dr (surgeon) Atul Gawande's "The Bell Curve: What Happens When Patients Find Out How Good Their Doctors Are?" in the New Yorker/12.06.2004. It is simply the best-most profound health"care" article* I have ever read ... by a long shot.
(*Until patient care & patient safety & outcomes measurement & physician-acute care center accountability improve dramatically, I vow to spell h_____c___ as you see above: health"care.") (I also now call hospitals "killing fields" ... e.g., recent stats show an unnecessary hospital death in the U.S. every 2 minutes, 38 seconds.)
Dr G: "It used to be assumed that differences among hospitals or doctors in a particular specialty were generally insignificant. ... But the evidence has begun to indicate otherwise. What you tend to find is a bell curve: a handful of teams with disturbingly poor outcomes for their patients, a handful with remarkably good results, and a great undistinguished middle.
"In ordinary hernia operations, the chances of recurrence are one in ten for surgeons at the unhappy end of the spectrum, one in twenty for those in the middle, and under one in five hundred for a handful. A Scottish study of patients with treatable colon cancer found that the ten-year survival rate ranged from a high of sixty-three percent to a low of twenty percent depending on the surgeon. ...
"It is distressing for doctors to have to acknowledge the bell curve. It belies the promise that we make to patients who become seriously ill: that they can count on the medical system to give them their very best chance at life. It also contradicts the belief nearly all of us have that we are doing our job as well as it can be done."
The stunning, appalling, fact-drenched article uses Cystic Fibrosis, where data has been rigorously collected (oh, so rare!), as a case study. Gawande reports, for example, that among the "best" (quotes again!) specialist CF centers, expected longevity systematically varies by 15 years!
Frankly, a drugged-out newsboy wouldn't be as sloppy at running his business as is the average hospital-medical specialty. And I, with one wee voice, refuse to urge "doable steps," as one attendee at a health"care" lecture I gave urged. I want ... Revolution.
I am accountable for my actions! I am measured against my peers by Clients and the whole damn planet every damn day! So are you! Why not His Preciousness, your Doc/Surgeon? Why not hospitals? Cut the crap! Shove the excuses! I personally have no problem spending 15% of our GDP on health"care." I have a big problem spending that much for crappy, uneven, unmeasured results!
The emperor has no damn clothes! He ain't wearin' shorts ... and he sure as hell doesn't merit a white coat! He is ... STARK NAKED ... and someone/s needs to say so/shout so ... LOUDLY! (I hereby volunteer.)
P.S. Yesterday's (12.05) Boston Globe Magazine, headline, p 30: "Left Behind: The stories are scary. A patient finds that his surgeon left a sponge or maybe a clamp in his body. But Atul Gawande is trying to write happier endings."
P.P.S. See also Gawande's prize-winning, readable, profound Complications.
P.P.P.S. See my Special Presentation, "Health'care': The Rant".
Forward to ...
Hospital administrators-you-know ...
With the Following Note:
Before blogging became all the rage, Tom was posting book reviews and Observations (essentially early blog posts) to this site. You can find the archives below.
What we're talking about
on the front page.