His talk was great, I'll write up my notes tomorrow. It's going to be podcast at some point, available from the
Seattle Public Library website. I was immeasurably impressed by his humility, his knowledge of his fallibility, and his genuine curiousity and diligence in pursuing what he wants to figure out. Also, the fact that he not only writes as a regular columnist for the NYT and articles for the New Yorker, he teaches at Harvard, performs at least 400 surgeries a year, and has a young family.
― Jaq, Friday, 4 May 2007 04:11 (eighteen years ago)
Here's the notes:
Free coffee! Crawling with med students. Jeff Goldblum sexy! Ha, checking Red Sox scores on Blackberry before talk. "Complications" from trainee POV, focus on choosing a profession with mortality as a consequence of his fallibility. Read from chapter "Naked" re: male physician/female patient trust & impropriety in various countries/cultures; his own aversion to gowns. Medicine as a performance where it is so easy to make a mistake. The most graceful, expressive hands as he talks. Devoured books by athletes re: peak performance and practice. But medical performance differs from sport - taking responsibility for others: 1) Moral endeavor, 2) grand ambition of bringing science to every individual on the planet, 3) coordinated teamwork of so many people w/ consistency and reliability, 4) the need for humanity, gentleness, dignity, & concern. Medical practice is a bell curve, though people want to believe it is a shark fin. Examples: success rate of in-vitro fertilization varies from 5% - 75% with a median of 40%, depending on what facility. Treatment of cystic fibrosis in US is focused in 117 centers around the country, all using identical practices and protocols and treatments. Still a bell curve - typical clinic life span average: 33 years, top of the curve clinic life span average: 47 years. Why such a difference? Went to middle-of-curve clinic "looking for trouble" (Cincinnati) - but EVERYTHING was done right, by everyone there. Then went to top of the curve clinic "because they must have some secret drug" (Minnesota). Anecdote of goth teenage girl and crusty old academian doctor where doc displayed genuine curiosity, sense of humor, respect for patient. Stressing the incremental margin between 99.5% chance of falling ill and 99.95%. Persistence in questioning why patient wasn't really following through with treatments and meds, but again with respect and genuine curiosity, getting all details, encouraging subversion and rebellion in the young patient as a means of protecting their own health and the importance of acknowledging that WE failed (doctor and patient both). Diligence. Surveillence. Moral clarity of purpose (to do right). Bedside integrity. Thorough teaming of all staff. These were the differences from middle of curve to top.
2 components of error: ignorance & ineptitude (1970s philosophers, names??). Ignorance has decreased dramatically, but ineptitude is still the struggle (he calls it performance).
Questions:
Topics he doesn't know how to approach as a writer yet? Health insurance, because everything he's written has been too boring. New article Saturday (?) NYT on health care reform, hopeful it's not too boring.
Woman with major bitter chip on shoulder asks about what to do if healthcare facility refuses to ack. patient has been exposed to toxicity. (A.G. has absolute compassion in responding to questions - asks with concern if this is something the woman has personally experienced; she doesn't elaborate). Responds that there is an art to being a patient. A combination of pushiness and trust.
Where will healthcare be in 50 years? Responds he has no idea but can think ahead 10 to 20 years. The idea of metrics for getting the best from treatment is new (US agency: HRQ, undermined by certain docs when back pain treatment was thoroughly researched).
A man questions: This sounds like SQC (statistical quality control) techniques used in manufacturing - should Toyota get into medicine? Responds re: the examination of mistakes, data mining, appropriate correlation of data and application of conclusions.
Old guy harps about AG not focusing on "caring". If more doctors really cared, fewer people would die. Responds that he disagrees. Caring is definitely a minimum requirement, but it doesn't impact the quality of medical care or survival rate the way the questioner thinks. Describes the burnout of doctors who truly care but are thwarted by their institution (Walter Reed example). Concludes that doctors must have responsibility and humility and admit their own fallibility.
Final ? was another bitter woman re: cost of avastin (breast cancer drug that extends life approx 3 months but costs $100k). Response re: healthcare reform but hinted he wasn't convinced this particular drug was worth it.
― Jaq, Friday, 4 May 2007 16:27 (eighteen years ago)
Yeah, it's pretty much a book tour for
Better, so that makes sense. He did short readings from two different sections of it. I haven't read either of his books, but now have them both on request from the library.
― Jaq, Friday, 4 May 2007 17:36 (eighteen years ago)
nine months pass...