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Brilliant, Inclusive and Wrong!!
on May 25, 2004
This major effort seems to have touched all the bases. It leaves virtually no possible cause of medical errors unexamined. It does, however, seem to employ its excellence in describing gripping case studies as a distraction much of the time, often leading one's attention away from the root causes it seems to prefer not to pursue.
I refer, to cite but 2 examples, to 1.) the touch-and-go treatment of the selection and education of medical students and 2.) to the issue of the cover-ups that are the consequence of the "Brothrhood" of physicians.
Our impressively literate authors manage, disappointingly, to leave issues like these without much examination and to virtually leave considerations concerning them out of their "solutions."
They properly make much of the "culture" of physicians, yet offer no ideas as to how to modify this culture at the med school level, rather than after the wrong people (drug addicts, among others)have been trained and are wreaking havoc. Drug addicts, by the way can be picked up by tests before, during or after med school - as can asocial individuals. Such tests, strangely and destructively, are not employed in the medical culture (as they are in industry.)
Nor do the authors seem to be aware of the possiblity of, or to encourage the employment of, others than physicians and their handmaidens to try to right the problems that are killing hundreds of us daily. They, like most physicians, seem to prefer having foxes guard the henhouse. And, given the culture they describe, this traditionaly hubristic practice (self-policing or peer review) virtually insures that proposed solutions will be destructively doctor friendly and largely leave the patient to his own resources.
The systems oriented approach that they champion, and which the Bush administration and the AMA seem to have picked up on, has the advantage of being relatively easy to implement. Bush and the AMA are, therefore, all for electonic help for doctors, and advanced computers will certainly help, but GIGO (Garbage In-Garbage Out) applies to their computers even as it does to ours. And tired, incompterent, impaired or indiferent staff can readily compromise the efficiency of such aids.
Such solutions also distract from, and ignore, important needs such as those mentioned in the 2 examples noted above - without which meaningful reform of the medical culture simply cannot occur.
And so, I see their "solutions" as mere paliatives awaiting the more difficult structural changes that I and others have thus far only hinted at.
Reading this book is tremendously informtive about a lot of things (and it is entertaining) but don't confuse its contents with anything like a meaningful solution to the problems of American health care. It , emphatically, isn't.