Dr. Atul Gawande is quickly becoming my hero. Two weeks ago, I read his article in the New Yorker Magazine entitled "The Cost Conundrum" where he went to McAllen, Tx to figure out why healthcare there costs more than any other place in the country. By getting past all the stereotypical (and inaccurate) reasons people give for high medical costs, he delivers perhaps the most honest look at medical economics that I have ever read.
This week, Dr. Gawande is at it again. His current article is a print out of the commencement address he gave at the University of Chicago School of Medicine. In it, he states the solution to the health care crisis lies in finding "positive deviants." These are people and organizations who are doing what is right as opposed to doing what makes the most money. He believes that by following their example, the rest of health care can and will benefit. I love this idea because he is not saying we need to spend billions of dollars looking for a solution. He is saying that we have the solution right under our noses, we just have to look more to the fringe than the mainstream to find it.
Having spent the last 6 years of my life trying to figure out how to deliver great care to my patients despite the toxic insurance environment, I understand exactly what he is saying. Mainstream medicine is wrought with practices which have done a great job maximizing revenues from procedures and labs. But this has only served to increase overall costs while neither increasing life expectancy or the patient's quality of life (in fact, many times it decreases them). Financially, the temptation is constantly looming to jump into the fray and start offering more procedures even though ethically, offering these tests creates a dilemma of whether the decision to test is being done because of true evidence-based medical necessity or because it generates money. Despite this, there remains a staunch group of us on the fringe (in the ideal medical practice movement and otherwise) who continue to sacrifice in order to fight the honorable fight for our patients. I love the idea of being a positive deviant. I'm sure my patients love it too.
John Brady MD