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Fougner and Geraci-Ciardullo: Patient Care Is Not Meal Preparation

Posted Sep 03 2012 9:35am
Dr. Art Fougner and Dr. Kira Geraci-Ciardullo have written a nice essay on the perils of "big medicine" entitled, " Patient care is not meal preparation ".

In particular, they respond to the recent New Yorker piece by Dr. Atul Gawande urging that American medicine be run more like the Cheesecake Factory restaurant chain .

A couple of excerpts from the Fougner/Geraci-Ciardullo piece
The Cheesecake Factory succeeds because of standardization and efficiencies, with complete control over purchasing and production. What recipes work become menu items throughout the chain. What recipes don’t work are soon discarded, much as a rancher periodically culls the herd.

The Cheesecake Factory model of care seems to work best for elective surgery. It is no coincidence that Dr. Gawande uses his mother’s knee replacement surgery as his example. Her orthopedic surgeon’s efforts over the years have produced standardization, efficiency and excellent outcomes...

There’s a problem, however. The same standardization so successful in elective surgery breaks down for most medical care situations. Even Dr. Gawande admits that “a person is not a steak.” Patients are not food items, they are not widgets in an assembly line.
Therein lies the fatal flaw for Cheesecake Health System’s doctors: the intrinsic variability of presentation, variability of response to treatment, and variability of co-morbidities.
 (Read the full text of " Patient care is not meal preparation ".)

Yes, there is legitimate room for improving standardization and efficiency in health care, when it makes medical sense.

But too often, these can be a smokescreen for centralized government control over how doctors can practice and what services they can (or cannot) provide to patients.

Note: If you like this piece, you might want to subscribe to Dr. Fougner's Twitter feed .
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