Sanitation Dept

Getting your kicks

Reckless Endangerment

You'll Huff, and You'll Puff

Caduceus Wild

Do these extra tests make my bottom line look big?

Surgeon and writer Atul Gawande has a fine piece in the New Yorker that you can find here. He looks at two Texas cities with starkly different costs and outcomes for patients. He finds that higher spending correlates with poorer health among similar populations. The more time you spend hanging around hospitals the more likely you are to contract a disease, undergo a procedure that goes awry, die of boredom etc...

In fact, this is not news to doctors. My Dad, who was a surgeon, would counterpoint his cheery motto "A chance to cut is a chance to cure" with an occasional darker refrain of "A hospital is no place for a sick person."

A big component of this more treatment-makes-worse-health problem is "misaligned incentives." The patient and the doctor should have the same goal: maximizing health. But when doctors are in a position to recommend tests that are of debatable medical value, but profitable, well, it's easy to be tempted into believing that it's good medicine as well as good business.

The good news is that it doesn't have to be this way. Check out his story for examples of how some doctors have found a better way.

Read 'em and weep