Notes From Annals Of Health Care: Big Med By Atul Gawande Part One

Cover of "The Checklist Manifesto: How to...

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I am currently reading this article from the New Yorker Magazine and I actually have more questions after reading the article than before I read it. I understand Dr. Gawande’s premise that we need more of a need for checklists in performing medical services than freelancing (I meant this in a nice way!).

In the article it speaks of the Cheesecake Factory knowing its customers, will big medicine truly know its patients? Why are costs truly soaring in medicine? Why is the service mediocre at best with a poor level of quality? How does a hospital determine the rates of failure and complications? According to Nassim Nicholas Taleb, restaurants would be considered antifragile institutions. Would I describe our healthcare system in the same manner? Antifragile institutions learn from failure in that restaurants, as an antifragile institution, have to stay strong in costs, service and quality to continue improvement. How do they manage improvement? Should doctors be paid for results instead of services? Are healthcare reforms on the right track? How many medical facilities have instruction checklists.? This reminds me to reread The Checklist Manifesto by Atul Gawande.

What is “tacit knowledge” and is it actually used in surgery? How do we correct in this day and age without being overbearing? How does a hospital rate its efficiency? Exactly what is “guest forecasting”? How do hospitals actually do in controlling costs? Profit vs. Nonprofit? How many tests are actually necessary for the patient? What businesses or services follow a coordinated plan of action? Is all this too idealistic? Where do you get ratings on hospitals?

“Customization should be five percent, not ninety-five percent of what we do.”

John Wright

Is standardization really superior in surgery?

Quote From Page 58

“In medicine, good ideas still take an appallingly long time to trickle down. Recently, the American Academy of Neurology and the American Headache Society released new guidelines for migraine-headache-treatment. They recommended treating severe migraine sufferers-who have more than six attacks a month-with preventive medications and listed several drugs that markedly reduce the occurrence of attacks. The authors noted, however, that previous guidelines going back more than a decade had recommended such remedies, and doctors were still not providing them to more than two-thirds of patients. One study examined how long it took several major discoveries, such as the finding that the uses of beta-blockers after a heart attack improves survival, to reach even half of Americans. The answer was, on average, more than fifteen years.”

When someone is taught to someone how is the best way to assess the progress? How is the best way to disseminate innovation? Need to reread Where Good Ideas Come From by Steven Berlin Johnson.

Quote From Page 60

“Although fewer than one in four thousand Americans are in intensive care at any given time, they account for four percent of national healthcare costs.”

My emphasis on this: Absolutely unbelievable!!!


2 thoughts on “Notes From Annals Of Health Care: Big Med By Atul Gawande Part One

  1. Pingback: Notes From The Annals Of Health Care: Big Med By Atul Gawande Part Two | Consilient Interest

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