Word: doctorings
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Imagine the dilemma of a physician trying to watch over a loved one when things are going badly. Sherwin Nuland is a celebrity doctor; he was a surgeon for 30 years, teaches surgery and gastroenterology at Yale and is author of How We Die, which won a National Book Award. Last fall his daughter, 21, faced a crisis. She had been born with hydrocephalus--fluid on the brain. A shunt was put in, which worked fine for 21 years until it closed down. "She needed a total of four operations to get this straightened out," Nuland says. The experience tested...
Finding the right doctor is important: but so is choosing the right hospital. There are all kinds of guides that can tell you what percentage of heart-attack patients were prescribed beta blockers upon arrival or sell you a report about your particular doctor. The problem is that it takes a doctorate in statistics to sort out the data. "The world's best orthopedic surgeon will be sent everyone's disaster cases," says Wachter. "He may be spectacular and still have worse outcomes than the crummy surgeon across the street who has better outcomes because he gets the slam dunks...
Harvard's Groopman, who has written three books about the doctor-patient relationship, lived through his own doctor-patient nightmare. It started when his son had a medical emergency in July, which every doctor knows is the worst of all months to go to a teaching hospital. "The new interns and residents begin July 1," he explains. "There's a very morbid joke: don't get sick on the July 4 weekend." But years ago, when he and his wife were new parents, they were visiting her family in Connecticut for the holiday when their 9-month-old son became...
That was an extreme lesson in the value of experience; no one recommends seeking out doctors who are brand new on the job, and doctors admit to scheduling elective surgery--even planning childbirth--around the intern calendar. This is not paranoia: the average major teaching hospital typically sees a 4% jump in its risk-adjusted mortality rate in the summer, according to the National Bureau of Economic Research. But there is a larger issue that doctors argue about: which matters more, information or experience? Broadly speaking, a younger doctor is likely to have been trained in the newest surgical procedures...
...reforms made intuitive sense; but the unintended result, older doctors warn, is a 9-to-5 mentality that detaches the doctor from the patient. They fear that young doctors don't get the experience they need or build the instincts and muscle memory from performing procedures so many times that they can do them in their sleep. Even the residents may agree: in a 2006 study in the American Journal of Medicine, both residents and attending physicians reported that they thought the risk of bad things happening because of fragmentation of care was greater than the risk from fatigue...