Atul Gawande recently wrote in the New Yorker about standards of medical care, in an article entitled the Bell Curve. I couldn’t find the article on line, but here is some Q&A about it.
The thrust of the article is grappling with the issue that some doctors and care centres are better than others. If we can identify which doctors or surgeons are below average in survival rates, standards of care, etc. what should we do about it? First of all, should we tell people, and then if we do, what do we do about it when nobody wants to be cared for by the below average physician?
At the heart of this problem, to me, is the tension between individual and group needs. The group as a whole is better off if the below average physician continues to practice. Because below average care is better than no care at all. But the individual, of course, will want the best possible care. It’s possible that the only way to continue to have all those below average physicians practicing is not to tell their patients that they are below average.
At some point, the below average care becomes medical malpractice. But where is that point? And if you draw that line too high, then poor care, which is better than no care at all, becomes unavailable.
It’s easy for me to pontificate on this. I’m healthy. But I do have some experience. I’ve had two caesareans in my life. I strongly believe that the second one (a locum) would qualify as below average. I had much poorer recovery, and a much worse scar. But, even given that, I would prefer to have had the caesarean than to have had to wait another two weeks with increasingly high blood pressure and eventual pre-eclampsia for my regular doctor to return from holidays. (let’s pretend that there weren’t other intermediate options). In this case, poor care was definitely much better than no care at all.