Tag Archives: health-care

Medicine, Specialism, and the Scientific Education

In the commencement speech he delivered to the graduates of Stanford’s School of Medicine earlier this year, Atul Gawande eloquently (as ever) examined the state of modern medicine (in the U.S. specifically, the world generally), the problem with specialism, and the problem of specialists trying to fit into a system not necessarily designed for it.

I particularly like Gawande’s analogy on the experience of a scientific education:

The experience of a medical and scientific education is transformational. It is like moving to a new country. At first, you don’t know the language, let alone the customs and concepts. But then, almost imperceptibly, that changes. Half the words you now routinely use you did not know existed when you started: words like arterial-blood gas, nasogastric tube, microarray, logistic regression, NMDA receptor, velluvial matrix.

O.K., I made that last one up. But the velluvial matrix sounds like something you should know about, doesn’t it? And that’s the problem. I will let you in on a little secret. You never stop wondering if there is a velluvial matrix you should know about.

via Intelligent Life

Personal Responsibility and Our Irresponsible Behaviours

Even though we may be reluctant to pay a premium for our insurance because of others who engage in irresponsible behaviours (for example: smoking, overeating and health insurance), Sandeep Jauhar, M.D. reminds us of some pertinent results from the health care field.

Jauhar provides evidence that “punitive measures to force healthy behavior” do not work; reminds us that we all undoubtedly engage in some form of comparable, irresponsible behaviours (e.g. using a phone while driving); and that the issue of personal responsibility in health care is a lot more complex that we imagine:

Personal responsibility is a complex notion, especially when it comes to health. Individual choices always take place within a broader, messy context. When people advocate the need for personal accountability, they presuppose more control over health and sickness than really exists.

Unhealthy habits are one factor in disease, but so are social status, income, family dynamics, education and genetics. Patient noncompliance with medical recommendations undoubtedly contributes to poor health, but it is as much a function of poor communication, medication costs and side effects, cultural barriers and inadequate resources as it is of willful disregard of a doctor’s advice. […]

Healthy living should be encouraged, but punishing patients who make poor health choices clearly oversimplifies a very complex issue. […]

‘It’s the context of people’s lives that determines their health,” said a World Health Organization report on health disparities. “So blaming individuals for poor health or crediting them for good health is inappropriate.”

No mention of moral hazard.

The Health Care Debate To Date

For the health care debate that has been raging in America of late, I have subscribed to the same philosophy as Ben Casnocha:

I’ve decided I’m just going to read it about once it’s resolved.

You can’t keep up with everything. Rather than lightly follow along and skim articles and pretend to be informed, I’m consciously opting out. I rarely do this when it comes to current affairs — I’m kind of a junkie — but I must say, this time around, it feels liberating.

The debate was also covered widely here in the UK and coverage has, at last, died down. As such I decided it was time to start reading about the progress to date, and came across David Goldhill’s extensive and penetrating piece in The Atlantic that, as Alex J Mann rightly says, contains “everything you need to or should know [about the health care debate]”.

The piece begins with this admission;

I’m a businessman, and in no sense a health-care expert. But the persistence of bad industry practices—from long lines at the doctor’s office to ever-rising prices to astonishing numbers of preventable deaths—seems beyond all normal logic, and must have an underlying cause. There needs to be a business reason why an industry, year in and year out, would be able to get away with poor customer service, unaffordable prices, and uneven results—a reason my father and so many others are unnecessarily killed.

and continues with the following statement that really won me over:

So before exploring alternative policies, let’s reexamine our basic assumptions about health care—what it actually is, how it’s financed, its accountability to patients, and finally its relationship to the eternal laws of supply and demand.