The Perfection of Industrialization in Medicine and its Imperfect Effects
In a world full of innovations, should industrialization of medicine be the next step to a
more perfect health care system? Should there be entire hospitals dedicated solely to one
specific procedure or would a more precise scope in specialization take away from the
physician-patient relationship?
Industrialization of medicine would mean that doctors would be responsible
for one specific procedure or body part. For instance, instead of having a
surgeon who deals with all of the abdominal contents, there would be a
surgeon that specializes in the esophagus, another surgeon that specializes in
the colon, and yet another that specializes in the gallbladder.
PROS
CONS
Shouldice Hernia factory in Ontario,
is a hospital that exclusively does
hernia repairs and has a 99% success
rate.
Operations would be substantially
shorter.
There haven’t been many other types
of transfers to super-specialized
medicine so there is not much to say
if the transition would work with
other procedures.
Doctors would see a drastic increase
in patients each day.
Reoccurrence rates would be cut
down.
Duration of doctor patient
interactions would decrease.
Operations would cost half as much.
Hospitals would have to do more
procedures to make the same amount
of money.
There would be a lot more problems
outside a doctor’s scope of practice.
Residency and fellowship years could
be cut down
Malpractice insurance would
decrease.
Doctors’ location flexibility would
decrease, because they’d work in
procedure specific hospitals as
opposed to any hospital.
“Lucian Leape, a Harvard Pediatric surgeon
who has made a study of medical error,
explains, ‘a defining trait of experts is that
they move more and more problem-solving
into an automatic mode.’ With repetition, a
lot of mental functioning becomes automatic
and effortless, as when you drive a car to
work. A surgeon for whom most situations
have automatic solutions has a significant
advantage.
Atul Gawande, MD
General Surgeon,
Brigham and Woman’s Hospital
April. 1, 2003
Vs
“The idea of massively transferring care to
super-specialized departments would mean
an important restructuring of hospital ward
capacities compared to the current norms
(including technical equipment and staffing
as the current numbers of specialists could
not possibly fulfill the newly created superspecialized centers).”
Richard Cescka, MD
3rd Dept. Internal Medicine,
University General Hospital
Oct. 3, 2013
Questions to Consider
Should medicine be super specialized?
Does the best medical care require fully trained doctor?
If super specialization were to work, would it only work
for medical treatment, or could it be used for medical
diagnosis?
As a future physician do you think your job satisfaction
would increase or decrease with specialized medicine?
Interesting Quotes:
Atul Gawande, Complications: “I asked Brynes Shouldice, a son of the clinic’s
founder and a hernia surgeon himself, whether he ever got bored doing
hernias all day long. ‘No,’ he said in a Spock-like voice. ‘Perfection is the
excitement.”
European Journal of Internal Medicine: “Internal care, both outpatient and
inpatient, brings considerable economic gain. In comparison with superspecialized care, the main savings are represent by fewer physician visits, and
it is certainly more economical if one physician can take care of multiple
diseases rather then having patients visit specific medical facilities for each
illness.”
Atul Gawande, Complications: “Still, resistance to this vision of mechanized
medicine will remain. Part of it, stems from legitimate concern that, for all the
technical virtuosity gained, something vital is lost in medicine by machine.
Modern care already lacks the human touch, and its technocratic ethos has
alienated many of the people it seeks to serve. Patients feel like a number too
often as it is.”
http://www.elsevierdigital.com/ECIM_abstracts2013/ECIM_2013_1/in
dex.html#8/z
http://www.shouldice.com/at-a-glance.htm
http://whenyouareserious.com/?p=156
Complications: A surgeon’s notes on an Imperfect Science by Atul
Gawande