Whoops! Totally forgot to post this on Saturday

Professor Jennings’ promise that Atul Gawande’s book, Better: A Surgeons’ Notes on Performance would be an easy and enjoyable read definitely held true.  I even read parts of it leisurely in the park as suggested.  Gawande’s tone of voice throughout the book it casual, even friendly.  I found myself laughing at parts, especially during the chapter, “Naked,” which discusses the awkwardness and danger involved in a doctor’s attempt to perform as appropriately as possible when examining his patients in the buff.  (By the way, never say “boob” or comment on a patient’s tattoos or tan lines, for you future doctors).   This book touches upon many of the issues and factors that we have discussed in class, exemplifying the complexities of “the hospital” as a system with many dynamic parts that influence overall success. Seemingly simple standards, such as hand washing, are explained to be extremely difficult to implement.  Why is it much easier to enforce standards of hygiene in the operating room than in nonsurgical patient care? 

 These questions drive the goals of Deborah Yokoe and Susan Marino, women whose job it is to minimize the spread of infection within the hospital.  Maintaining hygiene is one of the many systematic intricacies involved in the smooth running of a hospital. He also discusses how efficiency in scheduling, staffing and stocking of materials are crucial.  I particularly enjoyed the chapter “The Mop Up,” which discusses the way medicine is administered in alternative circumstances. (The chapter about war also touches upon this). Gawande joins Dr. Pankaj in an effort to vaccinate 4.2 million children in Southern India, in only three days!  Doctors created a special marking system to distinguish between vaccinated and non-vaccinated children.  This chapter was particularly interesting to me because it mentions the possibility of patient mistrust or skepticism to medicine.  Some parents refused for their children to receive the vaccination, as a rumor spread that the Indian government was trying to sterilize Muslim children. I think that this is a difficult issue for doctors to face, not only on WHO expeditions, but also in the everyday hospital setting. What are you supposed to do when a patient refuses treatment?  In class, we began talking about some factors that influence consent, such as age and coherence.  I think the issue of consent is especially interesting when it involves children.   

To stray off topic a bit, last semester I conducted research on the now closed Willowbrook State School of Staten Island, New York, where hundreds of mentally handicapped children were administered live hepatitis cultures in an attempt to devise a vaccine.  The parents of these patients consented to the experimentation, but there was severe controversy surrounding these experiments (conducted by NYU’s Dr. Saul Krugman in the 1950s) since it was thought that parents were coerced to consent for their children’s participation in order to grant their children admission to the facility at Willowbrook. This is just one of many cases in which incentives were used to induce patient participation in experimentation, another includes the Tuskegee syphilis experiment performed on impoverished black men in the South.  Medical ethics are always sticky, anything that involved the endangerment of one’s health/life leads to vexed debate.