HEALTH CARE - Doctor's Orders

"Reassessing the value of care for chronic health conditions" PBS NewsHour 1/18/2017

Excerpt

SUMMARY:  Surgeon Atul Gawande says we need to reconsider healthcare's focus on generously rewarding physicians who practice heroic interventions, rather than those who practice incremental medicine for chronic conditions.  Gawande talks with William Brangham about the value of that kind of care, and the potential effects of a Republican repeal of the Affordable Care Act.

DR. ATUL GAWANDE, The New Yorker:  When you think about the future of health care and where we're going at this moment of debate, there's a transformation going on that involves a recognition that our focus in medicine has been on heroic interventions, like the kind that I do now as a surgeon.

But the biggest gains are coming right now from incremental medicine, from a commitment to the kind of steady, overtime management of complex problems like chronic illnesses that can add years to people's lives.  But that's work done by some of the people with the least resources in our health care system.

WILLIAM BRANGHAM (NewsHour):  So, who practices incremental medicine in our health care system today?

DR. ATUL GAWANDE:  Well, good examples, just look at the list of who the lowest-paid people are.

Pediatricians are at the bottom.  You would also look at internists.  You would look at psychiatrists.  You would look at family physicians, HIV specialists.  People who take care of chronic illnesses by seeing people carefully over time, those are the people who get the least money.

The people who have the most [pay] are people like orthopedic surgeons, interventional cardiologists.  And my point isn't that — you know, that we're — that there is something wrong with heroism.

My own son has a congenital heart condition, where his life was saved by a cardiac surgeon stepping in at 11 days of life to save his life.  But he is now 21 years old because of constant monitoring and working with him with a primary care physician and people who controlled his blood pressure, recognized problems before they arose, dealt with learning issues that were related to his condition.

And that's the only reason now that he's getting to live a long and healthy life.  That's what we're not rewarding.  They don't have the kind of resources and commitment that we are giving to people like me.  I have millions of dollars of equipment available to me when I go to work every day in an operating room.

The clinicians who keep my son going are lucky if they can have a nurse.