Atul Gawande diagnoses overuse
Boston surgeon and writer Dr. Atul Gawande unearths a medical mystery in Texas with reverberations for the nation's debate about revamping its healthcare system.
In an essay for the New Yorker, he visits McAllen, Texas, a town with unusually high healthcare costs. Not substantially different from El Paso, its residents accumulate $15,000 in Medicare costs per year, twice the levels of its neighbor 800 miles away on the Mexican border.
The difference is across-the-board overuse of medicine -- of tests, of referrals, of operations, of medical procedures -- he concludes. And more doesn't mean better, he writes.
"Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen," he writes. "If doctors wield the pen, why do they do it so differently from one place to another?"
In Boston, Beth Israel Deaconess CEO Paul Levy says McAllen is no exception, in a blog entry titled "McAllen, Texas = Boston, Massachusetts." On her blog, Alison Bass, author of "Side Effects: A Prosecutor, a Whistleblower and a Bestselling Antidepressant on Trial," calls Gawande's piece "a scary article and a must read" for anyone considering how to control surging healthcare costs.
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Elizabeth Cooney is a former
health reporter for the Worcester Telegram & Gazette, where she also was a
business reporter and an editor. Earlier in her career, she edited medical
books and journals at Little, Brown, and worked for Boston magazine.Boston Globe Health and Science staff:
- Gideon Gil, Health and Science Editor
- Ishani Ganguli, Short White Coat blogger
Gawande's essay was very interesting, indeed, but I was disappointed that he mentioned primary care only in passing, when it is the crux of our health care crisis.
The cost of medicine is not just driven by doctors. Let's face it, it is driven by our societal beliefs which include:
1) death is optional
2) 'the customer knows best'
3) 'If I want an MRI, I should get an MRI because I have good insurance' (not based on whether it is necessary or whether it will change the treatment)
4) the general belief that specialists are better than generalists when in fact generalists deliver more cost-effective, higher quality care.
Let's start talking about improving primary care, and start being more aware of our attitude of self-entitlement.
This could have been a wonderful insightful article on issues surrounding healthcare related costs.
What "surgeon/author Dr. Atul Gawande" provides however is an inaccurate, non-scientific diatribe based upon misleading data. His primary hypothesis centers on the following statement: "Nevertheless, if you have the patience to pore over nationwide Medicare data...In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average,” Gawande notes. “The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.”
AND THIS IS EXACTLY WHERE Dr. Gawande is misled, and carries forth with a cacophony of error.
Nowhere in his article does he address the "Winter Texan" aspect of Healthcare provision in McAllen, nor how this fact skews the Medicare data upon which he bases his over simplified analysis. The fact that each winter McAllen sees a near doubling of its Medicare age population certainly accounts for this differential. Maybe in his next analysis, he could understand the data before jumping to his predetermined conclusions.
It is no wonder that Dr. Gawande seems to favor the non-scientific literature, and "Imperfect Sciences".
He also failed to disclose his conflicts of interest relating to his personal bias for Clinton Era socialized healthcare.
This blogger might want to review your comment before posting it.