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

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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?

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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 .

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