Sunday, December 09, 2007


“Better” is a book written by Atul Gawande. He is a general surgeon working in Boston & also an assistant professor at Harvard Medical School & the Harvard School of Public Health. He writes about performance in Medicine, what it takes to be better at what we do as doctors, and how do we measure this ‘goodness’, for lack of a better word.

He uses real-life examples to explain his points of view, which is one reason why this book is so immensely readable, especially for doctors. It could be you or me that he is talking about.

An interesting issue he raises is that of litigation. As we all know, it has become an almost nightmarish situation for doctors practicing in the USA as far as litigation is concerned. Malpractice insurance premiums have skyrocketed especially for specialties like obstetrics & neurosurgery.

On the other hand, there ARE patients who have suffered as a result of medical errors. What recourse do they have if not for malpractice suits? Gawande highlights an approach that has been used by vaccine manufacturers which seems promising.

See, previously, the vaccine manufacturing industry was threatened by lawsuits from patients who had suffered from side effects of vaccinations. Out of the millions of patients helped by vaccination, one in ten thousand is affected by side effects. Like anything in medicine, there are always risks involved, even for the most mundane procedure. These victims would then file for damages (talking billions of US$ here). Because of these lawsuits, some vaccine manufacturers went out of business, prices of vaccines hiked up, stockpiles dwindled (you get the picture).

So the US government came into the picture. A 75 cent surcharge was imposed on each vaccine. This money went into a fund for children who are harmed by the side effects. A panel of experts had come up with a list of known injuries from vaccines, & whoever suffers from any of these injuries would be compensated, whether the injury is due to negligence or bad luck. Those still unhappy can still sue but apparently, few have.

Putting this in practice for physicians is a monumental task. Who would qualify for compensation? How do you put a dollar amount to an injury or disability or death due to medical error? Would doctors buy into such a scheme?

Another interesting issue he raises is that of falling income of doctors, mostly due to the fact that health care costs are managed mainly by insurance companies. Doctors not only have to deal with managing their patients, but now are faced with having to tread through the oftentimes obstacle-ridden course of managed care. End result: they lose money. Unfortunately, this seems to be happening in Singapore as well. Ironically, without insurance, many, including the well-to-do, would have a hard time covering health care costs. Medical care IS expensive. I don’t know the answer to this dilemma.

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