Tag Archives: Dr. Atul Gawande

Experts Call on Docs to Lead Cost Control

Doctors must play an integral role in reducing health care costs, health policy experts say. At the annual conference of consumer group Families USA, Dr. Atul Gawande and Dr. Ezekiel J. Emanuel said that doctors participating in reducing costs will have a greater affect than the health care law itself.

Dr. Atul Gawande / Frances Correa/ Elsevier Global Medical News

“Washington will not be able to save the costs. They’ll provide the framework, but in your communities, that’s where you’ll do it,” said Dr. Gawande, a health policy researcher and endocrine surgeon at Brigham and Women’s Hospital in Boston. Dr. Gawande said that the Affordable Care Act will provide the data for doctors to identify where to trim costs. Both Dr. Gawande and Dr. Emanuel said doctors can take a leading role in cost control by focusing on the sickest 5% of patients. According to a 2009 report from the Agency for Healthcare Research and Quality, the sickest 5% of patients account for 50% of national health care expenditures.

Dr. Gawande cited the work of Dr. Jeffrey Brenner. By analyzing medical billing data from practices in Camden, N.J., Dr. Brenner, a primary care physician, was able to map out the most impoverished areas with the highest health care costs. With a focused approach that included home visits and the help of social workers, Dr. Brenner decreased one patient’s inpatient hospital time from 7 months in one year to 3 weeks. While under his care, the patient lost 200 pounds, and quit smoking, drinking, and using cocaine. At the same time, the patient’s hospital costs decreased by 60%. Dr. Gawande wrote about Dr. Brenner’s strategy in a January 2011 article in the New Yorker.

Dr. Emanuel, a recognized expert on health and chair of the department of medical ethics and health policy at the University of Pennsylvania, Philadelphia, said rising health care costs threaten many aspects of American society, particularly education, workers’ wages, and the nation’s position in the world, as well as by putting an economic squeeze on middle class. Dr. Emanuel also served as special adviser for health policy to the director of the White House Office of Management and Budget from January 2009 to January 2011, where he helped craft the Affordable Care Act.

Dr. Ezekiel Emanuel / Frances Correa/Elsevier Global Medical News

“If you care about how our kids are going to educated in the future, you have to care about heath care costs,” Dr. Emanuel said, adding that increased health care costs directly affect tuition rates. For example, from 2001 to 2011, employer contributions to health insurance increased by 113%, according to the Kaiser Family Foundation. Meanwhile, tuition for public universities increased 72% over the past decade, according to the College Board. Dr. Emanuel projected that, as health care costs continue to rise, states will be forced to take the money from other programs, leaving education and health care at the greatest risk.

“We can reduce costs without sacrificing access … [doctors] have to be committed to doing that,” Dr. Emanuel said.

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Filed under Family Medicine, Health Policy, health reform, IMNG, Practice Trends, Primary care, Uncategorized

Avoiding Medical Mistakes

The New York Times on January 24 ran two sobering accounts of medicine gone awry. 

The more prominent, and by far scarier, was a chilling, front page article by Walt Bogdanich about two cancer patients who experienced horrible and eventually fatal adverse effects from messed up delivery of radiation therapy. 

The second, less visible episode appeared as part of a review of the book The Checklist Manifesto by surgeon Atul Gawande. The reviewer, cardiologist Sandeep Jauhar, included his recollection of watching placement of a central line catheter by a group of medical residents. 

central line catheter/image courtesy Chris Gregerson, http://www.lightstalkers.org

According to Dr. Jauhar, the residents had their sterile technique half right, dressing themselves in gowns and gloves and draping the patient’s upper body, but they erred by failing to also wear face shields and caps and neglecting to drape the patient’s lower body. The predictable result 2 days later: the central line became infected and had to come out. 

Dr. Jauhar’s review summarized the thesis of The Checklist Manifesto: A great way to avoid medical mistakes is to follow checklists. The contention by the author, Dr. Gawande of Brigham and Women’s Hospital, Boston,  is that medical failure occurs not so often from ignorance as from ineptitude: not properly applying what’s known to work, a practice that could be greatly aided by using checklists to ensure coverage of every important medical detail. 

A simple idea with the potential to save lives and cut nosocomial mistakes, but Dr. Jauhar voiced skepticism for widespread adoption. “Doctors resist checklists because we want to believe our profession is as much an art as a science,” he wrote in his review. 

He’s probably right, but I think there’s at least one other reason checklists will be slow to catch on: denial. Too often, I think, the feeling is that others make mistakes, not me. The accounts published today of botched radiation dosing and a compromised central line show that the stakes are way too high to avoid checklist safeguards. 

—Mitchel Zoler (on Twitter @mitchelzoler) 

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Filed under Health Policy, Hospital and Critical Care Medicine, IMNG, Practice Trends