Dr. Gawande’S Novel Shiny Thing

Dr. Gawande has a novel article inwards the proudly noted, President Obama himself had a virtually fortuitous epiphany subsequently reading the New Yorker article, in addition to summarily decided that “This is what we’ve got to fix.”

In “The Cost Conundrum” Gawande explored the differences inwards expenditures for Medicare beneficiaries inwards ii Texas towns whose names became synonymous amongst our wellness tending issues, the expensive McAllen in addition to the rather inexpensive El Paso, terminal that “across-the-board overuse of medicine” induced past times “a civilization of money” was the origin drive for the “extreme” expenditures inwards McAllen. The article, accompanied past times an example of a patient dressed similar an ATM machine, speedily became the foundational axiom at the base of operations of wellness tending reform efforts, in addition to commencement address at the Harvard Medical School, Dr. Gawande informed the bird of 2011 that medicine needs them to endure “pit crews” instead of traditional “cowboys”. I don’t know if Dr. Gawande watches also many John Wayne movies or also few automobile racing events, but old-time cowboys, although versatile in addition to capable of performing many tasks, e'er worked inwards coordinated groups of diverse sizes in addition to compositions, depending on the size of the outfit that employed them. By contrast inwards a pit crew, i member’s responsibility, which is strictly defined past times regulations, starts in addition to ends amongst the left bring upwardly lug nut fifty-fifty if the entire automobile is on fire. Despite the miserable pick of words, the message is the same: standardized, repeatable protocols of tending delivered past times “medical systems” are superior.

In this month’s number of the New Yorker, Dr. Gawande takes the systems approach to its logical conclusion. We demand Big Medicine. We demand chains of hospitals in addition to clinics. Big chains, similar the Cheesecake Factory. It seems that wellness tending tin also acquire from the eating seat manufacture or retail inwards general, since CVS in addition to Walmart are also fondly mentioned inwards the article. According to the story, Dr. Gawande in addition to his children had a lovely dining sense at the local Cheesecake Factory establishment, ergo chain restaurants when managed well, tin deliver a fantastic culinary sense for a rather affordable price. Of course, nosotros all know that in that location are hundreds of other chain restaurants that cannot, in addition to Dr. Gawande himself seemed really protective of his reservations at Per Se, but maybe the argue the Cheesecake Factory is in addition to therefore successful is the automation in addition to squad approach to nutrient preparation. No Iron Chefs here. H5N1 well-oiled (no pun intended) machine of  managers in addition to sub-managers in addition to workers at diverse stations of cooking, cleaning in addition to learning on the job, eerily similar to pit-crews, each responsible for a prescribed slice of work, contend to practise inwards aggregate a consistently repeatable fake upscale dining sense for people who receive got no sentiment what Per Se is.

Exploring the excellence of chain establishments is non unique to Dr. Gawande, although he may receive got simply turned it into official policy. Similar arguments were made lately past times Dr. Peter Pronovost, comparison wellness tending to the exclusive Capella hotel chain, an offshoot of the Ritz-Carlton glitzy chain, in addition to reached similar conclusions. One could wonder how these learned essays would address what virtually people recognize every bit hospitality chains, such every bit Applebee’s, Chili’s, Holiday Inn or Motel 6. One could also reveal that anybody amongst no item credentials could opened upwardly a eating seat or a Bed-and-Breakfast, or function at such “one-of-a-kind” place, simply similar in that location are no item instruction in addition to licensing requirements for working on a farm or for becoming a cowboy. H5N1 really interesting experiment would endure to require that each mom-and-pop eating seat should receive got a Parisian Cordon Bleu graduate inwards companionship to opened upwardly its doors, or that every Bed-and-Breakfast would demand a Glion graduate on staff. I wonder if inwards that case, anecdotal prove from hand-picked hospitality chains would nonetheless compare favorably to the one-off picayune establishments. I suspect not.

Dr. Gawande is proposing that medicine should move Big Medicine in addition to doctors move broiler “chefs” amongst a figurer monitor controlled past times “headquarters” hanging higher upwardly their “station”, or possibly nosotros don’t fifty-fifty demand those super educated doctors in addition to scullery maids tin function their means upwardly to “management”, simply similar his protagonist inwards the New Yorker even did, because he knew of no other house where he “could move in, know nothing, in addition to acquire overstep to bottom how to run a business”. They used to instruct medicine that means earlier nosotros had medical schools too.
So based on i dining sense at i chain restaurant, “liberals volition receive got to bring the increase of Big Medicine, in addition to conservatives volition receive got to bring the increase of potent populace oversight”. Just similar nosotros had to bring the increase of Big Farms, Big Banks, Big Automotive, Big Retail in addition to Big Corporate everywhere, all amongst potent lobbying oversight in addition to potent populace subsidies in addition to bailouts every bit necessary, in addition to a slow evolving Definition of character to hateful inexpensive plenty to move on the nouveau miserable from jumping out of the experimental pot of boiling water.