Longer looks: A surgeon examines his professional development

Sep 30 2011

Every week, reporter Jessica Marcy selects interesting reading from around the Web.

The New Yorker: Personal Best
I've been a surgeon for eight years. For the past couple of them, my performance in the operating room has reached a plateau. I'd like to think it's a good thing-;I've arrived at my professional peak. But mainly it seems as if I've just stopped getting better. During the first two or three years in practice, your skills seem to improve almost daily. It's not about hand-eye coördination-;you have that down halfway through your residency. As one of my professors once explained, doing surgery is no more physically difficult than writing in cursive. Surgical mastery is about familiarity and judgment. … As I went along, I compared my results against national data, and I began beating the averages. My rates of complications moved steadily lower and lower. And then, a couple of years ago, they didn't. It started to seem that the only direction things could go from here was the wrong one (Atul Gawande, 10/3).

MedPage: Why Do Doctors Cling To Continuous Fetal Heart Monitoring?
Nearly all American mothers are monitored during labor, and bad fetal heart strips are an important cause of high cesarean section rates. A recent report detailed the dizzying increases: Almost one in three babies was delivered by cesarean in 2007, the most recent year for which data are available. That rate has grown by more than 50 percent in a decade. I have performed hundreds of cesarean sections during residency, and many were the result of bad heart-rate strips. … No test is perfect. But almost every time we whisked a mother back to the operating room, and I cut through skin, fat, fascia, and finally the muscle of the uterus, expecting a blue, floppy baby, the child I delivered emerged pink, healthy, and a little bit angry. Were we saving lives and averting disaster? Or were we performing unnecessary surgery? (Alexander Friedman, 2011). 

Harvard Business Review: How To Solve The Cost Crisis In Health Care
U.S. health care costs currently exceed 17% of GDP and continue to rise. Other countries spend less of their GDP on health care but have the same increasing trend. Explanations are not hard to find. … But few acknowledge a more fundamental source of escalating costs: the system by which those costs are measured. To put it bluntly, there is an almost complete lack of understanding of how much it costs to deliver patient care, much less how those costs compare with the outcomes achieved. Instead of focusing on the costs of treating individual patients with specific medical conditions over their full cycle of care, providers aggregate and analyze costs at the specialty or service department level. Making matters worse, participants in the health care system do not even agree on what they mean by costs. … Poor costing systems have disastrous consequences (Robert S. Kaplan and Michael E. Porter, September, 2011).

The Atlantic: Why Mitt Romney's Health Care Record Won't Stop Him
In his new Washington Examiner column, Tim Carney runs through the conventional argument that GOP candidate Mitt Romney is uniquely ill-suited to challenging President Obama in 2012 (including that) "Obamacare was the catalyst for the GOP electoral victory in 2010. … So it's hard to imagine a worse leader for this fight than Mitt Romney. Romneycare in Massachusetts not only looks a lot like Obamacare, it literally was a model for Obamacare." It's true that a lot of conservatives think that way about a Romney candidacy, but their reasoning is unpersuasive for several reasons. Most obviously, there is every reason for the GOP nominee to run a campaign that revolves around the economy. It would be foolish indeed to run primarily against Obamacare, especially since the average American voter, whatever he or she thinks about the legislation, isn't exactly eager to trust the Republican Party's approach to health care, if the GOP can even be said to have a coherent approach. Do Republicans really want to pit Rick Perry's record on health care against Obama's record, have them discuss the merits a few times on debate stages, and have those exchanges determine the winner of the presidential election? (Conor Friedersdorf, 9/28).

American Medical News: Making Part Time Work
More physicians are figuring out ways to practice part time to raise children, achieve a work-life balance, pursue other interests or extend working years beyond expected retirement age. Thirteen percent of physicians worked part time in 2005, according to the 2010 Physician Retention Survey by Cejka Search and the American Medical Group Assn. This grew to 21% in 2010. When broken down by gender, 7% of male physicians worked part time in 2005, a rate that nearly doubled to 13% by 2010. With female doctors, 29% worked part time in 2005, and 36% did so in 2010. Physicians with part-time positions say the key to making it work is knowing what you want and having firm boundaries but being willing to be flexible. ... Some medical practices are finding that accommodating part-time requests can be to their advantage, particularly with a physician shortage that is only expected to get worse (Victoria Stagg Elliott, 9/26).

Columbia Journalism Review: Meet The Bay State's Uninsured
Last week the Census Bureau released new numbers showing that 5.6 percent of the population in Massachusetts remained without health insurance coverage. That's a 42 percent drop in the number of the state's uninsured since the law took effect in 2006. A new study by the Cambridge Health Alliance, one of the state's safety net providers, showed who was left out, putting a human face on those without insurance. The findings are illuminating given that the Bay State's health law is the model for the national law, which takes full effect in 2014, and the Romney-Perry feud often flares up around the topic of health reform in the state. (Trudy Lieberman, 9/26).