Richard Rathe, MD

Associate Professor of Family Medicine (ret.) and Medical Informatician

Atul Gawande “How do we heal medicine?”

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Cowboys vs Pit Crews

Key facts from his recent TED talk…

  • Modern doctors have 4000 procedures and 6000 medications at their disposal
  • In 1970 it took 2 FTEs to care for a patient in the hospital
  • In 2001 it took 15 FTEs to care for the same patient
  • Checklists and mandatory pauses help decrease mistakes

“We are all specialists now, even primary care physicians.”

Atul Gawande “How do we heal medicine?” (video)

To sum up his talk in two words, both the Intensity and Complexity of care have increased in the past forty years. This is not surprising when you think about it. What aspect of life in the US has not become more intense and complex? He focuses on how the education of physicians lags behind the realities of team-based care. This is a valid point as far as it goes. He does not speculate on why “even primary care physicians” are specialists and no one is charged with understanding the entire spectrum of care for individual patients? (So I will…) In a word, Economics! During the 1990s Medicare and other payers decided to stop paying for coordination of care by primary care physicians. This was exacerbated by division of outpatient and inpatient care in the past ten years (again primarily for economic reasons). The new focus on high-volume, episodic care leaves little time for the big picture. This is not a flaw in medical education and not a choice made by primary care physicians! Merely the predictable consequence of decisions made by insurers and the federal government.

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