Douche of the Month: A Continuing Series from MDOD

If you are a physician, you have probably read or heard about Dr. Atul Gawande’s New Yorker article concerning the escalating costs in medicine. This man has Obama’s ear and was a senior health policy advisor to the Clintons when they did such a great job with health care, so pay attention - here is a quick summary for those who have not read it:

Dr. G. visited the Texas town of McAllen to find out why it has the highest expenditure per Medicare patient in the country. After his visit, he concludes that certain doctors in McAllen are overutilizing services because of a profit motive; he makes a convincing argument that more procedures are performed and more tests are done because certain doctors treat patients like profit centers. He compares this model to the Mayo Clinic, a low Medicare expenditure hospital, which he characterizes as ‘patient centered’ and an institution that utilizes a ‘collaborative’ approach to care. Finally, he generalizes these lessons to medicine as a whole: Entrepreneurial physicians are bad; collaboration and holding hands while singing about world peace is good.

Read the article. It takes about 15 minutes. He is a good writer and he makes a compelling case. All that said, I think he is a douchebag. Read on:

First: why are physicians talking about this article so intently? Well, my observation is that there is a large cohort of MDs who are real self-flagellators. For example, they actually are upset that a physician organization will look after the financial interests of doctors as a primary goal. Yes, there should be (and there are) doctor groups that have patient care, education, medical research etc. as primary focuses. But to actively oppose an organization that supports your financial interests points to an underlying psychopathology that was likely acquired at UC Berkeley and a guilt complex that would make the Catholic Church proud. Outright greed and patient ‘churning’ for cash is obviously bad; trying to build a financially successful medical business, to me, seems like a good thing. The Physician Guilt / Self-Hatred Complex compels these docs to confuse and equate these two very different things.

That brings me to Dr. Gawande - his CV reads like something any baby-boomer parent would jerk-off into a bowl of corn flakes over: Associate Professor of surgery at Harvard, a graduate of Oxford and Stanford with an M.D. from Harvard Medical School. Unfortunately, even the most impressive credentials do not stop one from being a douche-tard. How could this over-educated scientist make such a basic mistake: extrapolating a general conclusion via analysis of the outlier. That is, by focusing on the single most extreme example of Medicare overuse (McAllen, TX), where it is clear something rotten is going on, and then concluding that this somehow identifies the problem as a whole is just illogical idiocy. That brings me to my next point:

In life there are a few simple rules: 1. no ass-to-mouth; 2. you’ve got to fight for your right to party; and 3. when writing an article in a major print publication, do not use some lame personal anecdote related to your fucking kid falling down the stairs, going to the ER with a subdural hematoma, getting a CT scan, staying overnight, getting another CT in the morning, then concluding that this provides an excellent example of overutilization of CT scans because the kid lived. Tape these rules to your fridge so your children will read and live by them. Listen, dummy, if your experience had been that the second CT had provided evidence that the hemorrhage had progressed and your child’s life was saved because of “overutilization” would you draw the same conclusion? Uh, like, I don’t, like, think so, and, oh yeah, you can overutilize my teabag on your face, genius.

Lastly, like Jesus said “Those who live in glass houses should not throw stones at a prostitute, unless they have a lot of loaves and fishes”, or something like that. Gawande throws these stones from his glass temple at Harvard: for example, getting your gallbladder taken out at a Harvard hospital costs roughly DOUBLE what it costs in the community, with no differences in quality of outcomes. Yeah, that’s right: at Atul’s hospital, procedures are much more expensive, with no quality differences… why? You ask. Well, it’s because the Harvard hospitals (“non-profit” hospitals, by the way) act like a monopoly and force insurers to pay much more than they do elsewhere. So guess what, Atul the Fool: maybe you should point the finger at yourself and stop suckling at the teat of your predatory employer.

Hear my warning: this is the man who will make broad health policy decisions under this administration. I have said enough. I rock. Etothepi out.