Analysis Of Overkill, By Atul Gawande

Maruthappu, M., Ologunde, R., Gunarajasingam, A.. (2012). Is health care a right? Health reforms in the USA and their impact upon the concept of care. Annals of Medicine & Surgery. DOI: http://dx.doi.org/10.1016/S2049-0801(13)70021-

The articles I chose for my annotated bibliography were about healthcare cost and quality. The theme in many of these articles was about healthcare cost and does it affect patients experience. In some settings like hospitals, the cost of quality affects patient experience. The largest component of the U.S. Gross Domestic Product goes to healthcare spending (17% in 2009), and yet the quality is unsatisfactory. It was also interesting to find out that more people die each year in the United States from medical errors than from highway accidents, breast cancer, or AIDS (National Academy of Science's Institute of Medicine, 2002).

Atul Gawande in his article “When the Doctor Makes Mistakes” exposes the mystery, uncertainty and fallibility of medicine in true stories that involve real patients. In a society where attorneys protect hospitals and physicians from zealous trials from clients following medical errors, doctors make mistakes is a testimony that Gawande a representative of other doctors speak openly about failures within the medical fields. In this article, Gawande exposes those errors with an intention of showing the entire society and specifically those within the medicine field that when errors are hidden, learning is squelched and those within the system are provided with an opportunity to continue committing the same errors. What you find when you critically analyse Gawande, “When Doctors Make Mistakes essay is how messy and uncertain medicine turns out to be. Throughout the entire article you experience the havoc within the medicine field as the inexperienced doctor misapplies a central line in a patient.

By 2001 it was brutally apparent that the U.S. Health Care system was in dire need of a reform in regards to quality and patient safety. Following two separate reports issued by The Institute of Medicine (IOM), To Err is Human (1999) and Crossing the Quality Chasm: A New Health Care System for the 21st Century(2001) the U.S. Congress requested the IOM review quality processes across multiple government funded health care programs. And understandably, “these reports described America’s healthcare system as a tangled, highly fragmented web that often wastes resources by duplicating efforts, leaving unaccountable gaps in coverage, and failing to build on the strengths of all health professionals” (Brown J., p. I – 15, 2013). Thus, the Committee on the Quality of Health Care in America released 6 aims to address key dimensions that require improvement in our health care system. These aims propose that our system needs to strive to be more Safe, Effective, Patient-Centered, Timely, Efficient, and Equitable (STEEEP). All of which were created to help overhaul our current health care system and, more importantly, narrow the quality chasm.

"Johns Hopkins patient safety experts have calculated that more than 250,000 deaths per year are due to medical error…" (John Hopkins Medicine). This soaring number has caused medical errors to become the third leading cause of death in the United States. For many people, medicine seems foreign and unknown. People who have lost loved ones due to medical error desperately look for a reason, and many times that blame falls upon doctors. Media has put a negative connotation on doctors as well, causing their reputation to plummet whenever a hospital procedure turns badly. A renown surgeon and author, Atul Gawande, uses his knowledge and experience to give people a new perspective on medicine. In the article "When Doctors Make Mistakes," Gawande uses rhetorical appeals: ethos, pathos, and logos to prove the need for a change in the medical systems and procedures. He analyzes how the public looks at doctors, giving a new perspective to enlighten the reader that even the best doctors can make mistakes.

T.R. Reid uses cost, quality, and choice to fully evaluate healthcare systems all around the world. As an American citizen, I have always thought our system was unfair. The poor suffer more than the rich for going to see a doctor for the same reason. In chapter one of The healing of America, T.R. Reid comments on how many Americans have also started to notice that the American healthcare system is not as great as we once thought. Not only is it unfair, but it is also expensive and unsuccessful (9). By looking at all the other countries’ healthcare systems, Reid would then be able to better pinpoint how America can better its health care system by taking portions of those health systems.

According to the Institute of Medicine, “At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors” (Kohn et al.). Despite the unfortunate consequences, medical errors provide an important foundation for medicine. An immense uncertainty envelopes the medical field, and frequent leaps must be made. Some of these ventures are prosperous; however, many render unsuccessful. In Complications, Atul Gawande crafts an alluring view of the medical unknown using tales of his personal medical mistakes. Through the use of ethos, logos, and pathos, Atul Gawande argues that medicine’s vast uncertainty has beneficial influence upon society.

HMOs are not the only answers to cost control. Most physicians practicing in the United States consider their profession to be very much a form of art (Kleinke). The definition of art infers that within its sphere there are many variations and preferences. After all, one should not ask Picasso to carve like Michelangelo. Physicians too differ in their methods of treating patients. However when needless tests and procedures are done the treatment will cost more. This is waste. Many suggest that cutting waste will lead to a cut in quality. This is not necessarily true. Consider the following: an otherwise healthy forty-year-old male

Substandard quality of health care is duly recognized as a major form of medical crises with potential to jeopardize the functioning and purpose of the American health care system. Whereas on the one hand medical costs of treatment are rising, on the other malpractices and non compliance on the part of medical professionals and institutions compounds the problem and seriously questions the quality of health care being provided to citizens. However, before proceeding further it is important to understand what is exactly meant by the substandard quality of care. The substandard quality of

Shannon Brownlee writes of the flaws of the medical field in her book Overtreated. Medicine is one of the largest businesses in the United States, we spend now trillions of dollars on the health care system and most of it is wasteful spending. Wasteful spending includes: unnecessary tests like MRI’s, over prescribing drugs, and many ineffective surgeries. Many of these surgeries are unnecessary and can lead to problems in the future that can lead to even more surgeries that could have been avoided. Brownlee believes that this overtreatment is what is essentially wrong with the health care system today. This has led to excessive spending and a debate between affordable health care and well paid salaries for doctors, whose salaries weren’t as high as they are known to be today.

falls short compared to other countries stating that our annual deaths due to medical errors are in the tens of thousands (Filson, Hollingsworth, Skolarus, Quentin-Clemens, & Hollenbeck, 2011). They view this lack of quality of care as depending on what provider you see and where. The United States compared to other countries is in last place when it comes to mortality rates and quality of care (Davis, K, et al, 2014). The authors go on to say that the millions of people who are uninsured and those who are considered to be under insured only add to the gap of quality because these individuals do not have access to basic health care and this also adds to the $130 billion spent on those folks who are not insured or that do not take advantage of preventative

Henderson, a well known transplant specialist. Dr. Henderson believes medicine in the United States has become a repetitive system of doctors who prescribe patients with similar symptoms generic prescriptions, whether it is surgery or just a medicine, instead of focusing on the individual patient’s needs. He believes the inflation of medical care costs are associated with doctors doing the same thing over and over again. I can personally relate to this because, in February of 2015, I was emitted into the hospital due to excruciating stomach pains. The doctors did not know what was wrong with me, but after I was in the emergency room for over 48 hours, they decided to take out my appendix. Before I went into the surgery, the surgeon reassured me and my parents by saying she has done this surgery hundreds of times, proving an appendectomy is a go-to surgery for stomach pain. The uncertainty of the success of the surgery resolving the problem worried me and my family. Luckily, the surgery did eliminate the preexisting pain. If it had not, however, my parents would have been out thousands of dollars that would go directly to the surgeon’s pockets. Socialized medicine would be able to resolve problems like this one by increasing the quality, safety, and outcomes of each procedure. Dr. Henderson uses the example of Scotland to explain how socialized medicine increased the quality, safety, and outcomes of each procedure. Compared to the United States, Scotland is a lot more advanced medically. The United States can get to Scotland’s level of healthcare by adopting a program of socialized medicine similar to

3.2 trillion dollars are spent every year on the United States healthcare system (CMS). Estimates report that on average there are 2.6 million deaths in America on a yearly basis (CDC). The source of these calamities is simple: a poor healthcare system. Until American political parties arrive at a consensus, this country’s citizens will continue to fight the war on healthcare. Meanwhile politicians and hospitals fight each other tooth and nail, Atul Gawande, in his article “Overkill”, takes an insider approach into the current health care system to uncover the flaws that are that are forcing patients to collectively pay trillions of dollars each year for healthcare. However, while he does pose valid claims, he misinterprets the culprit and

Underlying Rationale. Epistemology: Given the open-ended nature of our lines of inquiry, we determined a qualitative approach was the optimal approach to characterize decision-making at the provider level. We have studied about the level of preventive service delivery from surveys of physician’s self-report, medical chart review, billing data, or patient surveys. Even though these sources are useful, they have many limitations. Physicians incline to over-estimate the rate of delivery of services to their patients (M Weisberg, 1985) (DE Montaño, 1995). In the case of the medical record, providers document more accurately, the some services and procedures (such as screening procedures) that are more important or billed compared to services (such

Written about the structure and culture of biomedical heath care and a society that is attempting to prolong aging, Medicare funding, funding and development of research, and today’s definition of standard care, Sharon Kaufman brings to light the many dilemmas posed to the American health care system. Her ethnographic story, Ordinary Medicine: Extraordinary Treatments, Longer Lives and Where to Draw the Line reveals the booming biomedical research and clinical trials industry, the power held by Medicare and private insurance, and a rapidly changing standard of care once a medical treatment is considered reimbursable. This leads to systematic changes in the standard of care result in a massive amount of pressure being placed upon doctors, patients and families to make an ethically and medically sound decision in refusing or accepting therapy. Kaufman exposes the driving forces behind the expansion of biomedicine, society’s response to the growing industry on a personal and bureaucratic level.