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Atul Gawande – Moral Hazard ‘r Us

You have to check out this piece from the current New Yorker:

Who knew that Health Affairs would be undone by cat cartoons and ads in the back of the magazine for weird shoe sizes?

This is a brilliant piece because it shines a light in so many directions:

• Dr. Gawande and the CT for his kid (wouldn't we all want one more confirmatory scan?)

• The closing sentence re: health care technology prevalence across bum-!*ck America.  What a paragraph!  Them there crappy Texas towns perhaps ain't got no good school buses or any of them new teachers that is trained right or the good new firetrucks with the red and blue sirens, but they got one hell of a collection of magnets over there at the hospitals.

• I was on a call with [a very large health care group purchasing organization] this morning (true story).  I sent them the link last night...told them to look at it before our call.  "Mike, that was an interesting story...what should we take away from the piece?"  The hospital execs sitting there very calmly, very politely--entirely unaware that they were the health care outlier of the Universe.  Beautiful.  That's the story with every hospital in the country.

• Love the part about the stents.  Got chest pain?  Putting in a stent.  Had an extra value meal at Arby's with jumbo fries--let's get the cath cart out.

I'll leave you with this.  Email from my friend John S. (Amber/Bob have spoken with the good doctor) LATE last night:

On Fri, May 29, 2009 at 12:52 AM, John S <john@s.org> wrote:
Well written article, Gawande knows how to tell a story. He briefly references Tulsa in the last paragraph - I can pretty much name the "fellow surgeon" he is talking about. Its not hard, we have a city full of them.

From my perspective as a disgruntled primary care doc living thru a large, academic organization's failing struggles to grapple with economic crisis... I see this as a very good description of the problem(s) with American healthcare. I'd like to think that the quality argument will eventually win over quantity, but quantity pays REALLY well (and we only have hints that quality will be important, maybe, sometime, hopefully soon). The forces of evil don't want anything to change at all and will defend the status quo fiercely.

There is tremendous opportunity here - to provide a method for docs to better understand the impacts of their behaviors (medical decision making for those decision where there isn't much evidence) in a way that they can actually change what they do  - not just to make a buck (or more likely, not lose a buck) but to move the quality needle. From my experience, most docs are not by nature greedy bastards. Some certainly are, and they've seized enough control, or at least influenced the direction of healthcare finance. I think most docs would be overjoyed to work towards improved quality of the care they provide, even if it is cost-neutral.

There are thousands of Grand Junctions out there in need of something to help give them traction. That is where we come in. Imagine this same article 5 years from now and it finds that communities/organizations that used weekly quality data fed back directly to physicians were twice as healthy as those that did not.

But I'm rambling...

-js

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