Internist Pens Summary

Seven in ten deaths in the United States, are attributable to chronic disease (“Leading Causes” 1). These diseases are not on account of bacteria or viruses, which could be treated with an appropriate prescription or vaccine. Chronic conditions are developed through unhealthy lifestyles and behaviors such as a lack of exercise, poor nutrition, poor sleeping habits, and substance use (e.g. tobacco). Consequently, seven in ten of every death can be prevented with changes in lifestyle. The CDC states that these conditions, “are among the most common, costly, and preventable of all health problems” (“Chronic Disease” 1). Although these conditions have clear and definite causes (knowing the exact reason and “cure” for them), they are becoming more prevalent rather than domesticated. According to Wu and Green, “Between 2000 and 2030 the number of Americans with chronic conditions will increase by 37 percent, an increase of 46 million people” (1). This increase comes with an increase in health care costs: the CDC reported that the U.S. spent three trillion dollars on health care in 2014 (“Health Expenditures” 1). 86% of these costs was associated with these conditions (“Prevention” 1). Despite there being a range of causes of why patients make these choices, one issue that may be less familiar to others is the lack of knowledge in preventative medicine among health care professionals. Current training standards are not adequately educating or equipping health care professionals

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.

All too often in regards to medical treatment, physicians are taught everything known about the scientific approaches to disease but still fail to realize the important details of how the disease impacts the individual. Many physicians do not show empathy to their patients and instead just focus on the current diagnosis and the probable outcome. This creates a divide between patient and provider and can even lead to negative feelings of the patient that far outweigh the diagnosis itself. A feeling of hopelessness and despair may accompany the empty feeling that comes with failing to explore the patient’s perspective on care. In this essay, Parrish states,

"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.

As described by Dr. Atul Gawande in his book Complications, medicine “is an imperfect science, an enterprise of constantly changing knowledge… fallible individuals” making medicine different from other scientific fields

When it comes to health care in the United States, the initial thought many people have are the many growing controversies concerning Obamacare, vaccinations, and making sure all Americans have access to affordable and quality health care. However, what many people fail to realize is a certain aspect in the medical community that, since the early 80’s with the infamous study by Berkman and Frankel, is increasing at such a tremendous rate that the Columbia Medical Review has referred to it as an “epidemic in the medical community.” The statistics regarding the number of individuals who die each year due to medical errors is rising; slowly becoming a major concern in the field. Doctors are busy individuals and at the end of the day still

Ambiguity and lack of regulatory control is echoed in David Powner’s article published in the Lancet Journal: “Clinicians do not always follow an established policy or provide appropriate documentation. Surveys or chart reviews showed that doctors sometimes failed to document specifics of clinical examinations, omitted criteria demanded

In 2010, the U.S Department of Health and Human Services crafted the nation’s 10 year health agenda. Healthy People 2020 outlines key objectives aimed at improving the standard of care health consumers receive by improving both the quality and format of health information offered to consumers as well as improving the consumers’ ability to obtain and process that information. These objectives included supporting shared decision-making between patients and providers, increasing health literacy skills, and delivering accurate, accessible, and usable health information that is targeted or tailored to the individual. (“Healthy People.gov” 2015)

In “En Route” by Abigail Zuger, Zuger compares two doctors one is Dr. Data and the other is Dr. Confidence. She describes them as people who follow the rules to strictly instead of showing a little more compassion for patients. Zuger describes Dr. Data as a “fact man, who is evidence based all the way” pg. (825) and she describes Dr. Confidence as a “Standing joke” Pg. (826) she also says “He seems to know no actual medicine at all” Pg. (826). Zuger says that neither Dr. Data nor Dr. Confidence will last a moment in her world because she treats her patients like people and not just as a simple patient. She actually connects with her patients, not like Dr. Data and Dr. Confidence who would basically spit their patients out of their consultation

Quality health care is an issue in America for everyone, despite our numerous tests and advances in technology. In his article, “Overkill,” Atul Gawande argues against a common assumption that our healthcare system is the best because of these medical advances. In fact, Gawande claims that our health care provides much unnecessary care that often causes harm and that costs a lot . He follows that claim by redefining “low-value care” as “no-value care” and provides considerable scientific data along with his own experience with his own patients to support his claim. He also states logical reasons by referring to expert authorities who critique our health care by viewing it from an economic perspective: like talking about information asymmetry where a doctor is more informed than the patient, thus the doctor has more power over the patient. All of these emphases strongly defend his controversial claim. But what stands out most is how Gawande uses several stories showing vastly different outcomes, depending on how informed the patient and doctor are including offering non invasive treatments. We need to explore how his unusual storytelling strategy exposes how surgeons and patients should care more about quality than the mere quantity of tests and what alternatives are available to change the unnecessary over testing and over-diagnosis which prevent good health care.

An issue in the medical world today is that expensive tests and procedures are being done unnecessarily. In his article “Overkill” Atul Gawande, surgeon at Brigham and Women’s Hospital, in Boston, and a professor in the department of health policy and management at Harvard School of Public Health argues that as someone in the medical profession he sees how unnecessary some medical procedures are. “The researchers called it “low-value care.” But, really, it was no-value care” (Gawande). Many people today are easily influenced by the power of the internet it’s as easy as googling a symptom and and coming up with a diagnosis and going into doctors offices and demanding a test or procedure, what these people don’t know is the cost of these tests

In that time, a treatment plan has been formulated and is as follows: take the medicine prescribed, eat healthy, exercise daily. This treatment plan is lacking in ways to actually improve daily quality of life and is a result of hurried, inattentive, and prejudiced physicians with whom my mother has a troubled relationship. In an article on concordance, Bissell, May, and Noyce emphasize the importance of the patient’s experience, goals, and knowledge in interactions between doctors and patients (Bissell et al, 2004). The treatment plan does not acknowledge or address my mother’s experiences, goals, or knowledge of her disease. Her experiences with doctors has been disappointing at best. She recalls a former primary care physician who, after listening to her describe her symptoms and the way she felt, would pat her on the knee and tell her, “Well, you look pretty good so you can’t feel that bad.” In an appointment for a cyst on her knee, the doctor chastised her for being on a plethora of medications, saying she was too young to be having so many problems. Upon examining her cyst, he told her that the cyst could not be causing the amount of pain she was having and if she really wanted it gone, she needed to “Give it a good ol’ whack with a Bible.” He further accused her of doctor hopping and drug seeking before sending her out of his office in tears. The doctor she saw specifically for pain was “too busy” to administer the

A physician must be well rounded in a variety of fields to provide effective care. First, an interest in learning scientific knowledge must be accompanied by the ability to translate that knowledge into methods of treatment. Because science is constantly changing and improving, a physician should be continuously expanding their scientific learning within and outside of their respective fields. Most of the coursework that I have taken reflects my interest in the intersection between biomedical science and its applications through an anthropological lens. For example, I have performed public

In conclusion, power can never be owned by one party or the other, but instead is activated through a relational dance in patient-physician encounters. The medical community needs to move away from the old traditional attitudes of paternalism, in which the physician knows best and instead adopt an independent choice model. In the independent choice model of decision making, “the physician objectively present patients with option and odds, but withhold their own experience and recommendation to avoid overly influencing patients” (Quill, 1996). The goal should be empowerment of both parties in which patients and physician work together towards shared decision

The doctor-patient relationship always has been and will remain an essential basis of care, in which high quality information is gathered and procedures are made as well as provided. This relationship is a critical foundation to medical ethics that all doctors should attempt to follow and live by. Patients must also have confidence in their physicians to trust the solutions and work around created to counter act certain illnesses and disease. Doctor-patient relationships can directly be observed in both the stories and poems of Dr. William Carlos Williams as well as in the clinical tales of Dr. Oliver Sacks. Both of these doctors have very similar and diverse relationships with multiple patients