Tuesday, October 17, 2017


  Writing the Surgery post, I got a short reprieve from the real picture. I thought those steps and sources and questions would help us get the doctor we want.  Then a 5 yr old NY article re-issued re  Twitter, from one of our most famous doctors, threw cold water on my hopes.

Dr. Atul  Gawande sees our chances of getting an excellent doctor as definitely not guaranteed.  The article, THE HEALTHCARE BELL CURVE is subtitled "What happens when patients find out how good their doctors really are/"  And as I read on, it seemed to I had to face ..or how good they aren't.  Dr. Gawande, as he makes clear in his book, BEING MORTAL does not sit in an ivory tower and tell us what to think.  He travels to the places where medicine is or is not practiced in excellence.

He draws us in with the first chapter of a story of  a sick little girl, Annie; who we find has been taken to the famous hospital that is the very wrong one for her. 

Then we learn why it's so tough to find a find doctor:  The Bell Curve--how does it look?  "What you tend to find is a bell curve: a handful of teams with disturbingly poor outcomes for their patients, a handful with remarkably good results, and a great undistinguished middle."
 He doesn't expect complete perfection nor movie miracles in impossible situations.
  "What one really wants to know is how we perform in typical circumstances.   After I’ve taken out a thyroid cancer, how often do my patients have serious avoidable complications? How do my results compare with those of other surgeons?"

How can we stay away from the poor or worse ones?  He tells us it's not easy to get the facts: 
The results of their treatments is hard to get - in some cases hospitals and specific illness groups don''t always keep track.  And keeping track is hard to do, in part because of privacy laws.

Attempts to keep score by number of deaths also doesn't impress him--there are emergencies and uncommon variances.  But sometimes differences by hospital, for example, are unexpectedly dramatic.  "A Scottish study of patients with treatable colon cancer found that the ten-year survival rate ranged from a high of sixty-three per cent to a low of twenty per cent, depending on the surgeon."  And that's not the only disease with scary differences.

Maybe the doctor we're considering doesn't even know where he is on the curve - so what will we get when we ask? 


If you don't want to read the whole story of records & and improvements in CF, Annie's disease, at least you might like the story of how a CF doctor in Gawande's "good" example, deals with a very young patient who's been backsliding, and how he makes a deal with her, and gets her back to safe self-care.

It's a happy ending.  Shows us in an action what can be done.  But where does such care fit into  our  fifteen-minute MD visits?

Of course, we want good hospitals,and good doctors who have the best knowledge, and who can think. 

We can't just hold on, live with that cancer or whatever we suffer from, until our medical schools turn out more greats, and the answers:  my brother died while doctors admitted they were keeping him alive until a better cure became available.  We want more hospitals that let the best doctors do what they need to do, when they need to do it.  


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