Pysician, Better Thyself

BETTER: A SURGEON'S NOTES ON PERFORMANCE
BY ATUL GAWANDE
METROPOLITAN BOOKS, 288 PAGES, $24

WANT to compare computers before you buy one? How about hotels, cars and 401k's? No problem. Plenty of people will even help you sort out the best options for your budget. In most sectors of the economy, consumers rule. Not so in medicine. It's difficult for health experts to compare health-care providers, let alone consumers.

Make no mistake: In most respects, American health care is the best in the world. But it is also in the midst of a crisis. Millions of low-income Americans can't afford health insurance, employers are groaning under the strain of paying for health care for their employees and government insurance programs - Medicare and Medicaid - are fiscally unsustainable.

But "fixing" health care is easier said than done. Improving medicine is not like designing a better widget. Patients and doctors are individuals with their own unique stories, skills and problems. Cookie-cutter solutions, from government or anywhere else, will only end up encouraging mediocrity. At the end of the day, harnessing the human element - the day-to-day interaction of patients and doctors - is the key to improving health care.

Atul Gawande, a surgeon and professor at Harvard Medical School and a staff writer at the New Yorker, knows this intimately. "At bottom," Gawande writes, "success comes out of a constant struggle between the details of how the world works and the character and ability of the people in it - out of the human struggle to do better."

Gawande's collection of essays, "Better," shows how doctors in widely varying fields have struggled to improve care. His most intriguing suggestion for improving medicine comes from an essay where he shows that some doctors and hospitals routinely outperform their peers - and yet patients and other doctors rarely know who the high performers are or how they might imitate them.

One expert, Donald Berwick, suggests a simple but radical change: Patients should have total access to information affecting their care. This, Berwick thinks, "would make it clear that the well being and convenience of patients, not of doctors, were paramount."

Gawande is on the right track. Today, doctors send their bills to public and private insurers, who pay them "piecemeal," for each procedure they perform. This system is very expensive, and leads to perverse outcomes - like paying a doctor more for treating a heart attack than preventing it.

A patient-focused health-care system would give consumers the information and tools to make routine health-care decisions, and reward providers that kept consumers healthy and saved them money. Competition would spur constant innovation and reduce insurance bureaucracy, liberating physicians and patients alike.

"Better" should be required reading for every first-year medical-school student, and for all policymakers who think they can legislate medicine. If enough people read it, "Better" might help to make health care better.

This piece originally appeared in New York Post

This piece originally appeared in New York Post