In his New Yorker
article, “The Checklist,” and his book Better:
A Surgeon’s Notes on Performance, Atul Gawande speculates on various strategies,
which doctors and nurses can undertake to increase the quality and success of
medical care. For example, he explains that simply using checklists can dramatically
decrease the risk of making errors that cause death. If doctors and nurses were more diligent about washing their
hands they would be able to lower the amount of deadly infections that patients
can get.
I think that Gawande explains very effectively why using
methods like these are beneficial to patients. However his article and book also
make it clear how challenging it can be to implement these new techniques. It’s difficult to find time to wash ones
hands every single time. Checklists can seem tedious. More complex problems,
like how to provide care for a patient who doesn’t have the right insurance, are
also an obstacle to most doctors (putting aside that horrendous doctor who
charged patients in cash and made 2 million a year).
I think we have focused a lot on the types of errors doctors
and nurses make. Gawande talks about that, but he also makes it clearer to me
as to why these errors are occurring, and why it’s difficult to implement
methods to discourage them. It seems to me that a lot of the problem had to do
with the current structure of our health care system. For example, there aren’t
enough doctors and nurses. As a result hospitals are understaffed so doctors
and nurses don’t have time to wash their hands and care for patients. Additionally
Doctors have to battle insurance companies to provide their patients with
proper medical care. I just feel
like the health care system needs to be seriously restructured to address these
obstacles. The AMA could allow for
more doctors to enter the system so hospitals would be less understaffed. I
know I always come back to this, but a public health care system that
eliminates private insurance companies, would make both the question of doctors
salaries and how to treat low-income patients less of an issue. If structural changes
are put into place it might be less of a challenge to implement the checklist
system.
I agree with Samantha's last sentence about the need for structural changes in order to effectively implement things like the checklist system. Reading Better, particularly the chapter "On Washing Hands" got me thinking a lot about our discussions in class and recitation about the sociology of professions and exactly what it means to be a medical professional in the United States. I was pretty shocked at the reluctance of many doctors and nurses to wash their hands between patients despite the efforts to make hand washing convenient, and the overwhelming evidence that doing so reduces the spread of infections in hospitals. Perhaps because being a doctor comes along with such great prestige, doctors become defensive or are reluctant to adhere to new and probably annoying policy changes because they are experts in their field and do not feel that outsiders should be able to advise or criticize what they do. When looking at the countless problems with the American healthcare system, this is by no means the most pressing issue; however, I do think it is an important thing for policy makers to consider while trying to change the way things work. Perhaps if important new policies were presented to medical professionals in a different manner that did not undermine their authority and prestige, doctors would be more cooperative with things like washing hands.
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