Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
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More from Gawande
25 Jun2009
Atul Gawande: The Cost Conundrum Redux
Gawande answers many of his critics, but I wonder if we really understand the issues. As I look over his many tables – this response is much more academic than the original article – I see that the most expensive community is also the most “under doctored.”
I wonder whether McAllen has many family physicians or general internists. I would bet not.
Adequate primary care (using the IOM definition) decreases unnecessary health care costs. Having less physicians in the community does not necessarily decrease health care costs.
Clearly there are many reasons for high health care costs. The most important health care reform that would help is re-aligning the incentives for physicians, because we do create many health care costs.
Important and interesting read.
Related posts:
- One more thought on rationing
- The process of care – lessons from Gawande and Saban
- In which Evan Falchuk explores health care reform
- Thinking inside the box will not work – we need a new box
- Wachter on Checklist Manifesto
Related posts brought to you by Yet Another Related Posts Plugin.
- In: Medical Rants
3 Responses to More from Gawande
Web Media Daily – Thurs. June 25, 2009 | Reinventing Yourself...
June 25th, 2009 at 12:10 pm
[...] More from Gawande [...]
Bohdan A. Oryshkevich, MD, MPH
June 25th, 2009 at 3:09 pm
I think that Dr. Centor has it exactly right. There is no primary care and no cognitive infrastructure in Hidalgo County. The tables of Dr. Gawande in the new piece may support that.
I have seen the same syndrome in inner city NY. Patients get little in primary care. The population is not healthy. But once they get diabetes mellitus or HIV/AIDS etc the spigots of care do not stop. This is expensive care with poor results.
Medicaid mills feed the problem since harrassed MDs simply send cases to ERs where specialists find them.
If one looked at population segments in NYC that demographically are similar to the resident of Hidalgo County you would find some of the same kind of patterns.
Maybe not as extreme but there.
Hidalgo County has no institution of higher learning than a high school.
Primary care and health care reform means educating doctors at Harvard to serve such counties in TX, NM, AK, and inner city Detroit. We are very far from that.
Bohdan A. Oryshkevich, MD, MPH
solo dr
June 27th, 2009 at 7:08 pm
In my area a univeristy-sponsored residency combined with a health care foundation is the only entity willing to see new medicaid patients. They receive grants and the doctors brag that well child visits are reimbursed higher than private insurance plans, once the grants for seeing underserve people in bulk come in.
These same people have doctors assigned for outpatient only and inpatient only medicine and maintain their priviliges at only one local hospital. At least half the Medicaid plans have moved to a capitated rate and trying to assigne a primary care doctor. The problem is the patients use the other hospital, where the residency doctors do not have privileges. The rest of us have to take care of these patients when assigned on call, often for free.
For the private doctors, a Medicaid 15 minute visit pays around $32, with $2 coming from the patient as a copayment. For most doctors, this does not even meet overhead.
The only way a public plan will succeed in the US is with fair fees and incentives for preventive medicine. Medicare is the closest thing to a successful government plan, and Medicare is running out of money.