Monday, February 7, 2011

Nothing but Questions

Dr. Atul Gawande wrote an article in the New Yorker a couple of weeks ago. It’s a real story about real people, in real trouble, and the real doctors who choose to really care for them. And from this story we can draw a real lesson for a real solution to the real health care problem we are facing.
Unlike Dr. Gawande’s previous articles which fit nicely into policy, this one doesn't seem to generate nearly as much "buzz". Why is that?

Is it because the implication that if you want to save money in the long run, you need to go back to basics and actually take care of people on a basic human level?
Is it because this is too much hard work with no instant gratification from high-tech silver bullets?
Is it because we don't really want to put the patient at the absolute center of our efforts and would prefer to use representative data about the patient instead?
Is it because we prefer academic theory to execution, particularly when execution involves poor, dirty, drunken, sick people that need to be physically touched?
Is it because this flies in the face of both "personal responsibility" advocates and "get rid of mom and pop medicine" proponents?
Is it because it does not fit well with the patient as "consumer" paradigm?
Is it because it shines the light away from social media savvy crowds back to the simple realities of being poor and sick, and the true concept of "community"?
Is it because the doctors in the story are just plain good people, instead of greedy, patronizing, error-prone, rich doctors who don’t even wash their hands?
Is it because it implies that poverty is at the heart of the health care costs conundrum?
Is it because we all decided, in our respective left and right corners, that we know how best to solve the problem and a trifle little thing like evidence is not going to stop us now?

Perhaps the questions are wrong and perhaps there are no answers. Besides, the train has already left the station……

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