Malpractice litigation + health insurance + Atul Gawande's Better

I've been working my way through Atul Gawande's Better, and as I'm writing this, I realize that I'm more than halfway through, which surprises me a little. I don't feel like I've read that much...sign of a good writer?

I loved his debut, Complications. My boyfriend asked the other day, so is the 2nd book really better? Ha. I'd say it's more serious. By this, I don't mean that Complications dealt with fluff, but the topics that he chose to cover in Better (litigation, health insurance, patient privacy) definitely reflect the years that has passed--and its requisite experiences, feelings, growing bitterness?, definitely growing disillusionment--since his residency, when he wrote his debut.

There are many passages of the book that has stuck with me, but the most recent one pertains to malpractice litigation:

The one defense of our malpractice system is that it has civilized the passions that arise when a doctor has done a devastating wrong. It may not be a rational system, but it does give people with the most heartbreaking injuries a means to fight...And although it does nothing for plaintiffs, people whose loved ones have suffered complications do not then riot in hospital hallways, as clans have done in some countries

When I read that, I thought, Ha, that's what happens in China. Where do I begin? The doctors who get ambushed publicly when loved ones day? The reporters who get maimed for investigating doctor misconduct? The lack of respect and satisfaction doctors in China feel? Reading that passage above made me suddenly wondering, would a better justice/legal system not only help human rights and other areas but also the health system? Just a thought.

Gawande then goes on to talk about health insurance: insurance considerations start from the moment someone calls to make an appointment. Making sure they have insurance, making sure you as the doctor falls in their insurance's network, making sure the insurance covers the visit or service, making sure the patient is aware that he/she has to bring in money for the copay, entering in the right referral number, preapproval numbers, insurance-plan numbers, diagnosis codes, procedure codes, visit codes, tax ID number, etc. etc. Reading it just makes my head spin, I don't want to think about actually doing all of that...Just like Gawande, I've heard from doctors, almost-doctors, and potential doctors alike that insurance is/was their biggest concern. And I can kind of get a feel for that. No wonder concierge practices are getting more popular. More on this later. (I'm shadowing a concierge doctor now.)

Dr. Abraham Verghese

This man is amazing. Another hero to me. Up there with Jim Yong Kim and Suzanne Farrell...he gives me hope and inspiration for pursuing medicine and arts at the same time and finding unexpected but welcome connections between the two.

At Stanford, he is on a mission to bring back something he considers a lost art: the physical exam. The old-fashioned touching, looking and listening — the once prized, almost magical skills of the doctor who missed nothing and could swiftly diagnose a peculiar walk, sluggish thyroid or leaky heart valve using just keen eyes, practiced hands and a stethoscope.

Art and medicine may seem disparate worlds, but Dr. Verghese insists that for him they are one. Doctors and writers are both collectors of stories, and he says his two careers have the same joy and the same prerequisite: “infinite curiosity about other people.” He cannot help secretly diagnosing ailments in strangers, or wondering about the lives his patients lead outside the hospital.

Physician Revives a Dying Art: The Physical

Relevance of today's primary care physicians

Recently, our group at work was hit with sickness: one girl got acute bronchitis, one had a cold, and another probably had acute bronchitis as well but...never went to get checked out, which really is the whole point of this post. From said coworker's adamant refusal (stubborn reluctance?) to go see a primary care physician to a news report about the high percentage of over/misdiagnoses probably due to greater reliance on online sources (WebMD), it seems as if the relevance of health care delivered by primary care physicians (PCP's) is decreasing.

People can easily go to webmd.com to look up symptoms for many diseases like breast cancer and be convinced that they have said disease.

I'm probably exaggerating. Growing up in a frugal yet health conscious family, I've only gone to get check ups from a pediatrician when an external source required it (e.g. school, work). Each time, the check up was very uneventful. I was a normal, healthy girl. And so beyond allowing me to join the school's swim team or to work, those check ups never seemed very worthwhile. So, it's easy for me to say that the services provided by a PCP are not relevant to my life, but it's beginning to feel the same for many other people, too. What do you think?

If people are using PCP's less and less and thus rendering their role less and less relevant to our health, I wouldn't be surprised. On the way to work the other day, I noticed how many radio advertisements there are promoting medication for all kinds of diseases. (Are you suffering from <insert random-never-heard-of-before-disease>? Are you having trouble sleeping? Do you sometimes get up with aching joints? Is your vision getting blurry? If so, you might have said-disease. Miracle-drug-A can help. Ask your doctor about it today!) Listening to these so much, who wouldn't be tempted to over/misdiagnose? I mean, PCP's are still useful because you'll need them to fill out prescriptions, but you can probably get those from specialists, right? Or, even if you do go to your PCP to ask about the disease and medication, the tables have turned: people are not going to their PCP's for check ups or out of concern for an unsettling, persistent symptom, they are going to their PCP with an idea of what their diagnosis might already be, which they make known to their PCP. Does this affect their treatment?

I think so.