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November 11, 2005


Lance Williams

Those who appreciate Dr. Gawande's clear-eyed and thoughtful analysis of medical practice will be delighted to learn that the New Yorker is publicly posting two of his articles highly relevant to the concerns of this website.

The first, "The Bell Curve," discusses means of ensuring the quality of medical care -- other than malpractice suits -- and the obstacles to providing patients with information about relative quality of care, by physicians or institutions.

" . . . They had been told almost everything they needed to know in order to give Annie her best chance to live as long as possible.
"The one thing that the clinicians failed to tell them, however, was that Cincinnati Children’s was not, as the [parents] supposed, among the country’s best centers for children with cystic fibrosis. According to data from that year, it was, at best, an average program. This was no small matter. In 1997, patients at an average center were living to be just over thirty years old; patients at the top center typically lived to be forty-six. By some measures, Cincinnati was well below average . . . At Cincinnati, lung function for patients under the age of twelve—children like Annie—was in the bottom twenty-five per cent of the country’s CF patients. And the doctors there knew it."


The second, "Piecework," subtitled, "Medicine's Money Problem," addresses the contribution of physicians themselves to the current crisis in our system of care.

"Physicians in the United States today remain better compensated than physicians anywhere else in the world. Our earnings are more than seven times those of the average American employee, and that gap has grown over time. (In most industrialized countries, the ratio is under three.)"


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