How Malpractice Suits Are Damaging Health
Atul Gawande is a general surgeon at Brigham and Women’s Hospital and, since 1998, a staff writer for The New Yorker. In 2006, he received the MacArthur Award for his research and writing. His book "Complications: A Surgeon’s Notes On An Imperfect Science" was a finalist for the National Book Award in 2002 and is published in more than a hundred countries. His newest book, "The Checklist Manifesto," is one of Amazon’s best books of the month: December 2009. He and his wife, Kathleen Hobson, live outside Boston and have three children: Walker, Hattie, and Hunter.
Question: Does the fear of being sued ever affect a doctor's judgment?
Atul Gawande: I'm sure. I'm sure it does. Less so in the operating room. I think the place where it affects your decision-making is often in the office, where someone comes to you with a problem, it doesn't seem like a big deal, but then you get the what if? We had a meeting, for example, with -- a surgical meeting where I met a surgeon who was from Cedar Rapids, Iowa, and he was talking about some data they'd collected on how many CT scans they'd gotten in his hometown. This is a town of 300,000 people, and when they pulled out the numbers they found they'd done over 50,000 CT scans for the population in the previous year. The vast majority were normal scans that were probably unnecessary. On the other hand, what do we mean by unnecessary? So, 10,000 were largely for head scans, head CT scans, for people with headaches. Only a dozen found any abnormality. And most of those were unusual headaches. They probably could have followed guidelines that said that you don't need the head CT for nearly anything like the percentage of people who got them. But the fear of a lawsuit if you should miss something led to lots of scans. The irony here is, there is probably even more risk from the scans themselves. They have high doses of radiation. And the number of scans Americans are getting nowadays, we know they're generating hundreds if not potentially thousands of cancers down the road.
Question: How does it feel to make a mistake while operating on another person?
Atul Gawande: I still make them. You know, I operate on about 250 to 300 people in a year. I have a 3 percent major complication rate. At least half I can look back on and see that there were things we should have and could have done differently. And when you recognize that situation -- I wrote in my most recent book of a patient who nearly died on the operating table because I ended up making a wrong move that led to a tear in his vena cava, the major blood vessel going back to the heart, and he lost his entire blood volume into his belly in 60 seconds and arrested on the table. And it was just fabulous teamwork that saved him; that I got lucky. And what it feels like is shame. You know, there's guilt, which means you feel badly for what you've done; and then there's shame, where you feel that you are what was wrong. And because we are in a system where we want to convey to people that we are infallible, we have a hard time grappling with our own fallibility. And in a sense, I don't want that shame to go away. But we've got to use that sense of shame more productively. When that sense of shame leads us to clam up and not want to talk to even the patient about the situation, have a hard time being willing to let the public see our results because of fear of what the data might say about us, that's when it has paralyzed us and kept us from solving problems. Where it's good is **** feel responsible. And the culture of surgery has fundamental components that are driven in ways that make every surgeon recognize that they're fundamentally responsible, they're responsible for the results of their patients, even when it isn't necessarily their own hand that's slipping here. Things can go wrong in lots of ways.
Question: How can a person be a better patient?
Atul Gawande: It's a good question, because I think it is -- there are two things about it. Number one is there's no straightforward recipe. But there are things that we recognize we can do. I think number one is to understand that making the system work well is something that we're only starting to grapple with. Medicine has been about parts; it's been about having a great drug, a great doctor. It has only in the last few years started to become about making all of that fit together as well as possible. And the most important role, I think, that patients play is, they're the only ones that see when things are falling through the cracks. You see one specialist and then another specialist, but they don't talk to each other, and what they're telling you doesn't make sense or fit together. A third of patients by the end of their life have 10 or more specialists in their care. And we're not very good at knitting all of that together.
And so I think the most important part the patient plays is not being passive about their part on the team. They are -- we're not great at drawing out the patient; we've wanted the patient to be passive and not so involved, just do what we say. But the more we have different people involved, what we tell people is contradictory. It doesn't always help them the way it should. And as we get our act together, I think what we're learning is, the patients play a key role.
The fear of massive settlement fees has forced doctors to take a number of generally excessive precautions—including unnecessary CT scans that may cause cancer down the road.
Explore how alcohol affects your brain, from the first sip at the bar to life-long drinking habits.
- Alcohol is the world's most popular drug and has been a part of human culture for at least 9,000 years.
- Alcohol's effects on the brain range from temporarily limiting mental activity to sustained brain damage, depending on levels consumed and frequency of use.
- Understanding how alcohol affects your brain can help you determine what drinking habits are best for you.
If you want to know what makes a Canadian lynx a Canadian lynx a team of DNA sequencers has figured that out.
- A team at UMass Amherst recently sequenced the genome of the Canadian lynx.
- It's part of a project intending to sequence the genome of every vertebrate in the world.
- Conservationists interested in the Canadian lynx have a new tool to work with.
If you want to know what makes a Canadian lynx a Canadian lynx, I can now—as of this month—point you directly to the DNA of a Canadian lynx, and say, "That's what makes a lynx a lynx." The genome was sequenced by a team at UMass Amherst, and it's one of 15 animals whose genomes have been sequenced by the Vertebrate Genomes Project, whose stated goal is to sequence the genome of all 66,000 vertebrate species in the world.
Sequencing the genome of a particular species of an animal is important in terms of preserving genetic diversity. Future generations don't necessarily have to worry about our memory of the Canadian Lynx warping the way hearsay warped perception a long time ago.
Artwork: Guillaume le Clerc / Wikimedia Commons
13th-century fantastical depiction of an elephant.
It is easy to see how one can look at 66,000 genomic sequences stored away as being the analogous equivalent of the Svalbard Global Seed Vault. It is a potential tool for future conservationists.
But what are the practicalities of sequencing the genome of a lynx beyond engaging with broad bioethical questions? As the animal's habitat shrinks and Earth warms, the Canadian lynx is demonstrating less genetic diversity. Cross-breeding with bobcats in some portions of the lynx's habitat also represents a challenge to the lynx's genetic makeup. The two themselves are also linked: warming climates could drive Canadian lynxes to cross-breed with bobcats.
John Organ, chief of the U.S. Geological Survey's Cooperative Fish and Wildlife units, said to MassLive that the results of the sequencing "can help us look at land conservation strategies to help maintain lynx on the landscape."
What does DNA have to do with land conservation strategies? Consider the fact that the food found in a landscape, the toxins found in a landscape, or the exposure to drugs can have an impact on genetic activity. That potential change can be transmitted down the generative line. If you know exactly how a lynx's DNA is impacted by something, then the environment they occupy can be fine-tuned to meet the needs of the lynx and any other creature that happens to inhabit that particular portion of the earth.
Given that the Trump administration is considering withdrawing protection for the Canadian lynx, a move that caught scientists by surprise, it is worth having as much information on hand as possible for those who have an interest in preserving the health of this creature—all the way down to the building blocks of a lynx's life.
The exploding popularity of the keto diet puts a less used veggie into the spotlight.
- The cauliflower is a vegetable of choice if you're on the keto diet.
- The plant is low in carbs and can replace potatoes, rice and pasta.
- It can be eaten both raw and cooked for different benefits.
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