It occurs when the bar is lowered for what’s considered a real disease. For example, overdiagnosis presumably exists when we incidentally discover slow-growing cancers in older people. Basically, when we find a cancer that may not kill someone sooner than Father Time. And, as the story goes, we treat the cancer with lots of medicines, tests, and therapies–since the more diseases we diagnose in American medicine, the more treatments we recommend, and the more money we make, right?
After reading my latest post about conflicts of interest in healthcare, my wife suggested that I write a piece about butterflies. Something pretty, she said. Natural. Peaceful.
Since hostility is never my goal, I thought I’d give it a try.
I read for an entire evening on butterflies–their life cycle, behavior, mechanisms for protection, and how different cultures view them. All I could keep thinking about was how much my grandmother liked them. She lived for nature. Flowers. Birds. Butterflies. She stayed with me once as a child when my parents were out of town. She would literally drive only 10 MPH on the road if anything remotely beautiful were visible out the window. Butterflies included. During her visit that year, I intentionally directed her down the ugliest roads in town so we could get to where we were going more quickly. I know it sounds bad, but that’s what I did.
It’s about a female dog with only three legs. Her fourth leg was amputated following a traumatic accident as a puppy.
Now, when she walks, she has a hitch in her step. And, when she hitches, she kicks the stump of her injured leg outward.
Step, step, hitch. Step, step, hitch.
One day, the female dog has puppies. And, her puppies do what all puppies do. They nurse. They watch. They learn a little about the world around them from each other. But, mainly, they learn about life from watching their mom.
Before long, the puppies are walking. And, how might they walk? You already know. They walk with a hitch in their step. Just like mom.
This is a video (21 minutes, 33 seconds) of my lecture given at the Summit at the Summit: A National Grand Rounds on the State of American Medicine. The lecture aired during the conference webcast on July 23rd, 2015. Conference lectures can be re-watched by registering at LetMyDoctorPractice.org. The transcript of my lecture appears below.
Quality in medicine appears to have been formally first addressed around the 4th century B.C.E. in a collection of approximately 60 treatises known as the Hippocratic corpus. These writings outlined diagnostic methods of physicians but also detailed treatment failures for the benefit of all.
The corpus’s most famous surgical text, On Fractures, opens with a promise to discuss mistakes:
“I must therefore mention which of the physician’s mistakes I want to teach you not to do.”
The quest for quality throughout the corpus was distinctly a personal matter, centered on humility and the challenges of medicine:
“Life is short, the art is long, opportunity fleeting, experiment perilous, judgment difficult.”
This is one of the most famous statements of the Hippocratic corpus–its focus noticeably removed from a world-group or professional responsibility.
An independent company, known as ProPublica, made healthcare news this week by releasing the complication rates of nearly 17,000 surgeons nationwide.
ProPublica is another one of these non-profit groups that has been granted charity status by the Internal Revenue Service. Their self-stated mission is investigative journalism in the public interest.
You should know that ProPublica claims to be supportive of the “little guy.” I, too, like underdogs, so I enjoyed reading on their own website about their goal to shine “a light on the exploitation of the weak by the strong… [to expose] the failures of those with power to vindicate the trust placed in them.”
Giddy up, ProPublica.
I also favor transparency in medicine. In fact, I wrote a book, in part, to outline my support for it. But, ultimately, what I care about most is taking back medicine. Returning the practice of it to those things that are really meaningful to patient care. And, in our modern era of excessive third-parties mooching off the healthcare system, my focus has settled in on chiseling away at the less meaningful.
With that in mind, I’ll tell you about the “Surgeon Scorecard” that ProPublica has now made public.
Your doctor? Sure. But, he or she isn’t the only one. The pharmaceutical company? Of course. The medical device company? The hospital? The insurance company? You get the point. Everyone has an angle. Everyone has a conflict of interest. Know it. Get over it. It’s time to focus on something else.
Like filling up your car with gas. In fact, you better plug your ears when you do it. Heaven forbid one of those automated messages at the pump convinces you to buy a 42 ounce gulp of Pepsi. Just another angle, my friends. It’s called life.
But, medicine isn’t supposed to have any conflicts of interest, right? Healthcare instead should be like religion, or maybe, like politics… sorry, I’m now getting confused what’s supposed to be pure.
We just live at a time in America where so much of healthcare has become invented. And, the more we keep inventing, the more it seems that we lose track of what matters: the hopelessly out-of-date concept known as the patient-physician relationship.
Dr. Atul Gawande is an American surgeon and public health extraordinaire. He is one of the most successful physician authors of this century, and he writes routinely for The New Yorker. His most recent article discussing unnecessary healthcare is, as expected, a good read.
I applaud Dr. Gawande’s passion towards advancing medicine. And, yes, there is universal agreement that we need to be better in America at providing high-quality low-cost healthcare. There just remains disagreement on what our biggest obstacles are, and how they should be overcome.
I agree with Dr. Gawande on some things, but after reading his most recent opinion piece, I must caution you about several medical inaccuracies found within it.
If you didn’t know it left or that someone stole it, I’ll give you a pass. Medicine has been disguised for a long time now. And, when you leave the scene in camouflage, you often go unnoticed.
Medicine is supposed to be the science or practice of diagnosing, treating, and preventing disease. I love medicine. There’s so much to learn. Lots of complexities and so many people to help. Medicine gives me an avenue to serve, because if we don’t have our health, what do we have? Illness. And, none of us want that.
I’ve trained to be a physician. I’ve learned lots of things that can help you with sickness. But, in order to do this, THEY have to let me practice. And, yes, THEY are the people who have taken Medicine.