March 2, 2017
March 2, 2017
- Good morning. I’ll be at the Diocese today for a New Principal’s meeting.
- Mass tomorrow followed by Town Hall; Minimum Day staff meeting tomorrow at 12:30.
- Here’s Part III of a fascinating piece entitled “Tell Me Where It Hurts” by Atul Gawande in The New Yorker, January 23, 2017(or How is primary care medicine like classroom teaching?; my apologies for the length as I wanted to squeeze this excellent piece into 3 segments): Incrementalists “want us to take a longer view,” says Gawande. “They want us to believe that they can recognize problems before they happen, and that, with steady, iterative effort over years, they can reduce, delay, or eliminate them. Yet incrementalists also want us to accept that they will never be able to fully anticipate or prevent all problems. This makes for a hard sell. The incrementalists’ contribution is more cryptic than the rescuers’, and yet also more ambitious. They are claiming, in essence, to be able to predict and shape the future. They want us to put our money on it.” Around the time of the Silver Bridge collapse, the medical profession had little to offer patients in the way of prevention. Illness was seen as a random catastrophe and doctors focused mainly on rescue and insurance for unanticipated, episodic needs. Money was poured into heroics and incrementalists were scanted. But by the late 1960s, scientists were discovering the long-term significance of high blood pressure, diabetes, and other conditions and figuring out treatments that could save lives. “Seemingly random events were becoming open to prediction and alteration,” says Gawande. “There is a lot about the future that remains unpredictable. Nonetheless, the patterns are becoming more susceptible to empiricism – to a science of surveillance, analysis, and iterative correction. The incrementalists are overtaking the rescuers. But the transformation has itself been incremental. So we’re only just starting to notice.” The big salaries still go to surgeons and the like, while primary-care physicians and others in less-glamorous areas of medicine make half as much. Gawande says four kinds of information are important to a person’s health and well-being over time: [Think about parallels in schools.] Your internal systems – from imaging and lab tests; Your living conditions – housing, community, economic, and environmental data; The state of the care you receive – what practitioners have done and how well they did it, what medications and other treatments they have provided; Your behaviors – patterns of sleep, exercise, stress, eating, sexual activity, and adherence to treatments.
The potential of this information is enormous, especially now that we can monitor some of it through wearable devices and smartphones. But the potential will be unlocked only if we commit the resources to primary care. “As an American surgeon,” says Gawande, “I have a battalion of people and millions of dollars of equipment on hand when I arrive in my operating room. Incrementalists are lucky if they can hire a nurse.” One of the biggest causes of early death is hypertension, which can result in a stroke, heart attack, dementia, and other serious problems. Thirty percent of Americans have high blood pressure and only half are adequately treated. “Good treatment for hypertension is like bridge repair,” says Gawande: “It requires active monitoring and incremental fixes and adjustments over time but averts costly disasters. All the same, we routinely skimp on follow-through… More than a quarter of Americans and Europeans who die before the age of seventy-five would not have died so soon if they’d received appropriate medical care for their conditions, most of which were chronic.” “In this era of advancing information,” Gawande concludes, “it will become evident that, for everyone, life is a preexisting condition waiting to happen… But this is also an opportunity. We have the chance to transform the course of our lives. Doing so will mean discovering the heroism of the incremental.”
- Have a great day and God Bless you!