Tuesday, May 31, 2011

What's Wrong with His Argument?

What’s wrong with his argument?

In the midst of his commencement address to the graduating class of Harvard Medical School, Dr. Atul Gawande offered the following:

“The doctors of former generations lament what medicine has become. If they could start over, the surveys tell us, they wouldn’t choose the profession today. They recall a simpler past without insurance-company hassles, government regulations, malpractice litigation, not to mention nurses and doctors bearing tattoos and talking of wanting “balance” in their lives. These are not the cause of their unease, however. They are symptoms of a deeper condition—which is the reality that medicine’s complexity has exceeded our individual capabilities as doctors.” Link here.

Actually, there’s a lot that’s wrong with this argument.

To be fair, one thing that is not wrong is Gawande’s observation that today’s medicine is far more complex than yesterday’s. Medical treatment today is more often delivered by a team of professionals than by a solo practitioner. The era of Marcus Welby is over.

So far, so good.

Yet, Gawande is rudely suggesting that when older physicians talk about their experience, they don’t know what they are talking about.

He thinks that they have mistaken the symptom for the cause.

Thereby, Gawande has disrespected the group of physicians who are increasingly choosing to retire young.

More significantly, he dismisses the intrusions of outside forces on the practice of medicine. Surely, most physicians today feel stifled under the weight of “insurance company hassles, government regulations, malpractice litigation...” 
I will leave it to others to ascertain how much they are irritated by tatooed interns seeking work/life balance.

As it happens, regulations and malpractice laws are more burdensome in some states than in others. Currently, there is a migration of physicians to Texas, largely to escape bureaucratic regulation and malpractice litigation.

Physicians are moving to Texas because they want to spend more time practicing medicine and less time doing paperwork and navigating a bureaucracy. Can you blame them?

By making this an either/or question Gawande, perhaps unconsciously, sides with those extra-medical professionals who have invaded his profession and are driving young people away from the profession while they drive older physicians out of it.

His rhetorical sleight of hand gives the impression that he feels that we need not reform malpractice laws or streamline bureaucratic regulation.

It’s not an either/or question. It’s a both/and issue. If bureaucracies and lawsuits have made it that much more difficult to practice individual medicine, they must make it more difficult to practice medicine in a group.

Outside supervision and control, to say nothing of threats of lawsuits, does not enhance teamwork. It undermines it. When faced with threats most people, even most physicians, start functioning as though it's every physician for him or herself.


The Ghost said...

Anyone contemplating a career as a doctor today has to be insane ...

the day will come soon when they will be required by law to take on clients from Medicare and Medicade and will be paid rates below their costs ...

ever wonder why there are very few British born doctors practicing medicine in the UK ...

Stuart Schneiderman said...

Of course, you're right... and the reason does not lie in the fact that medicine has become more complicated. Most people enjoy a challenge, especially when it comes to healing illness. They do not enjoy wasting their precious time on paperwork, most of which is incidental to their task as physicians.

www.josemoretsa.es said...

This can't work as a matter of fact, that is exactly what I believe.