Grand Rounds is here ; I’ll be hosting the post-Thanksgiving issue.

Comments Off on Grand Rounds at Code Blog

Two snippets from a New Yorker interview with Atul Gawande :

You are a general surgeon. How often can you anticipate being sued in your career?

The statistics say that I should expect to be sued about once every six years. Now, there is some evidence that if you’re a nice guy and communicate well with your patients you get sued less. It’s not because you’re a better doctor; it seems to be because patients feel more loyal to you.

I’d argue that being a nice guy and communicating well with your patients is being a better doctor. I’ve seen plenty of examples of the opposite.

Are American doctors in a tougher position than those in, say, Great Britain or Canada?

The major difference between malpractice here and in Great Britain and Canada turns out not to be in the number of lawsuits. At this point, the U.K. and Canada seem to be catching up with our rate of lawsuits. The big difference is that the awards are far smaller. This is partly because of the traditions of their court systems, but it’s also because they have universal health coverage . Patients in those systems already have their medical expenses covered for their lifetime, as well as some disability benefits. So malpractice awards are restricted to other costs—lost wages, or compensation for suffering, for example—and these are much smaller costs on the whole.

My emphasis. Because people in the US have no guarantee that they’ll have health insurance tomorrow, or next month, or next year (and their medical error may become a “pre-existing condition”), when they sue for malpractice, they sue not only for pain and suffering, but they also sue for the coverage of their lifetime medical expenses.

Don’t like malpractice, docs? Listen better, and support national health insurance.

Update: Is Gawande wrong about the numbers?

4 Comments »

Zegerid is one of those bullcorn “me too” drugs in the worst kind of way. If massive advertisements for it start as the “latest treatment for heartburn,” it’s best to just put your fingers in your ears and shout “La la la, I can’t hear you la la la!”

Health Care Renewal has a great writeup on it ; it’s essentially the exact same thing as over-the-counter Prilosec or prescription Nexium, just mixed with baking soda, and dissolvable in water. (What a breakthrough! Congratulations, Pharma!)

Although 42 doses of over-the counter omeperazole [Prilosec/Nexium] costs about $25 at retail, Santurus is selling 30 doses of Zegerid for about $140.

“That’s a lot to pay for baking soda,” says the significant other.

If you buy this, you are an idiot .

13 Comments »

Healthy Policy has some information on the impact of Medicare Part D on people’s drug costs . (Unfortunately, if no one signs up for it because it’s so damn confusing, we’re going to get nowhere.)

Also: If you don’t sign up by May 15, 2006, you have to pay a higher premium!

1 Comment »

I had dinner tonight with The Malcolm Gladwell , and I say “The” like David Letterman says “I like The Doritos,” as if he’s a household name, because, well, he (Malcolm) kind of, sort of… is. (My mom told me to say to him for her.) He’s the guy with the big hair that wrote Blink and The Tipping Point and writes for The New Yorker. He is long-time friends with a friend (Ann and husband Chris) and she was kind enough to invite me along to a dinner. He’s in the area speaking today with Atul Gawande, another literary idol (he wrote Complications: A Surgeon’s Notes on an Imperfect Science ) and several other great New Yorker pieces.

So I’m kind of totally geeked-up excited about meeting him as it were; and he’s, like, pretty normal. Felt totally comfortable talking to him (the wine helped), and he was great to talk to. He’s interested in health care, so that definitely helped too; I find myself with less and less ability to relate to anything non-medical. I explained my cognitive dissonance theory to him , it being my latest theory to try to figure myself out, and the night progressed through health care reform, when it will happen, how it will happen, and even a little debate on Medicare Part D and the pharmaceutical industry. Although I still don’t fully see eye to eye with him on it, he convinced me on some points, and I’ll admit I didn’t know that generics were significantly cheaper here in the US. He also has an opinion on when health care reform will take place in the US, but I don’t want to spoil it if it’s his next article. We also talked about board game strategy, the UK version of The Office, and I ended up doing my terrible Cartman impression.

I think I’m infinitely envious of his job (or maybe more Atul’s–if I could read and write on fascinating things, plus do medicine, that’d be the ultimate), but, like a lot of things, it’s probably less fun when you have to do it as opposed to doing it for fun . I think one of his greatest strengths is his ability to take the everyday experience, make sense of it, find some data behind it, and explain all the facets of it. It’s almost like he writes things that you agree with on almost a “gut instinct” level, but then explains your gut away. (Me, I’m trying to lose my gut.)

And the kicker? I email Ann back after the evening thanking her for the invitation, and I get a great one-liner back:

Subject: to sum it up
malcolm gladwell loves you.

(Me? Big head? Never.)

5 Comments »