Atul Gawande (previously) is a highly respected expert on systems thinking, preventative medicine and dying with dignity has published an excellent editorial about the medical shortcomings of the Senate GOP's tax-break/health cut bill. Read the rest
Jon Mooallem's beautiful profile of BJ Miller tells the tale of how Miller lost three of his limbs in a stupid accident and became a pioneer of palliative medicine: but for me, it's also a story of the very best of San Francisco's blend of technology, optimism, compassion and exuberant weirdness -- a blend that has been changing for the worse since the dotcom bubble of the turn of the century.
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Jon Mooallem's beautiful profile of BJ Miller tells the tale of how Miller lost three of his limbs in a stupid accident and became a pioneer of palliative medicine: but for me, it's also a story of the very best of San Francisco's blend of technology, optimism, compassion and exuberant weirdness -- a blend that has been changing for the worse since the dotcom bubble of the turn of the century. Read the rest
The lecturer for the BBC's 2014 Reith lectures is Dr Atul Gawande, a celebrated author and MD whose book The Checklist Manifesto: How to Get Things Right is a classic on how to think about systemic problem solving (which pays attention to how different people and activities come together to make and solve problems). Read the rest
If you haven't read this 2008 New Yorker article about a woman who had a chronic itch on her head and over time scratched through her skull in till she reached her brain, here it is. And when you're finished, give this song a listen. Singer-songwriter Teddy Blanks was inspired by the article to compose and record The Itch.
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In “The Itch,” Atul Gawande wrote about a woman called M. who couldn’t stop scratching an itch on her head, so much so that, at some point, she scratched all the way to her brain. It was a gruesome read for some of us -- little, imaginary itches began to sprout, and it was impossible not to scratch. But for the singer-songwriter Teddy Blanks, it was an inspiration. Blanks remembers reading the article one day on the train and was, as he puts it, “squirming in my seat.” Later that night, as he tried to write, he saw The New Yorker on his bedside table. Unable to get Gawande’s words out of his head, he composed his own “Itch,” a little ditty about, well, itching.
The approach is marvellous because it is both data-driven (data-mining is used to identify which patients aren't getting the care they need) and extremely compassionate ("super-utilizers" are voluntarily enrolled in programs where they get 24/7 guaranteed access to doctors, nurses and social workers). The programs are successful, and even though they cost a lot to administer, they still generate system-wide savings -- one patient helped with this sort of care had previously cost $3.5 million a year because of heavy ER and ICU use. In other words, providing excellent, personalized care to the small number of patients who don't fit the system's model saves far more money than making the system more stringent, with more paperwork, higher co-pays and other punitive measures. It's a win-win.
Except that it's not really catching on. Some of the doctors pioneering this approach are frustrated because they can save Medicare or an insurer millions, but they can't get funded by Medicare or the insurers -- instead, they have to fundraise from private foundations. Read the rest
“Scratching is one of the sweetest gratifications of nature, and as ready at hand as any,” Montaigne wrote. “But repentance follows too annoyingly close at its heels.” For M., certainly, it did: the itching was so torturous, and the area so numb, that her scratching began to go through the skin. At a later office visit, her doctor found a silver-dollar-size patch of scalp where skin had been replaced by scab. M. tried bandaging her head, wearing caps to bed. But her fingernails would always find a way to her flesh, especially while she slept.Read "The Itch" | Listen to interview with "The Itch" author Atul Gawande Read the rest
One morning, after she was awakened by her bedside alarm, she sat up and, she recalled, “this fluid came down my face, this greenish liquid.” She pressed a square of gauze to her head and went to see her doctor again. M. showed the doctor the fluid on the dressing. The doctor looked closely at the wound. She shined a light on it and in M.’s eyes. Then she walked out of the room and called an ambulance. Only in the Emergency Department at Massachusetts General Hospital, after the doctors started swarming, and one told her she needed surgery now, did M. learn what had happened. She had scratched through her skull during the night–and all the way into her brain.