Complications - Atul Gawande Flashcards
Dr. Gawande cites a Swedish EKG study in which a computer was pitted against a top cardiologist in identifying heart attacks. Who won?
The computer was accurate in 20% more cases than the cardiologist.
What is special about the Shouldice hernia clinic in Toronto?
All they do are hernias. They are quick (30-40 minutes instead of 1-1.5 hours). They are efficient (1% of cases have recurrences compared with 10-15% at most clinics). They have no training as general surgeons. They simply overspecialized in one single type of surgery, and so they have achieved a machine-like level of efficiency.
So, the question is, are all the years of medical school and residency really necessary to produce high-quality physicians?
In various cases, including psychologists’ predictions as to the likelihood of parole violations and a computer’s reading of EKGs to identify heart attacks, which is more accurate, statistical analysis or human analysis?
Statistical analysis every time.
Humans are too swayed by personal histories, recent experiences, improper weighing of certain factors, the order in which we see things, etc.
Can we have both highly perfected medicine and the ability to train new physicians at the same time?
No. Residents need to learn. Mistakes will be made as they follow the learning curve. In this case, the patients’ well-being falls secondary to society’s need to train capable physicians.
What is a valid reason to resist the automatization of medicine?
Patients too often feel like just numbers as it is. Making the system more impersonal is a risk we face.
However, medical errors are far more severely damaging than the risk of a patient not feeling loved enough.
Are malpractice cases concentrated in a small subset of inept physicians?
No. They actually follow a bell curve distribution among all physicians.
How often does the average physician face malpractice litigation?
Most physicians (Especially surgeons) are sued at least once during their careers.
Do malpractice suits reduce medical error rates?
No.
Do all mismanaged patients sue? Are all lawsuits legitimate?
According to Dr. Troyan Brennan
Less than 2% of patients that receive substandard care will sue.
Only a small minority of those patients have legitimate claims.
What is the principle factor predicting a patient’s likelihood of winning a malpractice case?
How poor their outcomes were (Regardless of whether it was caused by disease or unavoidable risks of care)
How do academic hospitals try to correct for physician error?
Holding legally protected Morbidity and Mortality meetings once a week to recap all the issues and try to correct mistakes for future cases.
Does nausea produce any helpful evolutionary benefit?
Yes, it allows us to remove toxins from our bodies and creates an aversion to whatever substance harmed us in the first place.
What purpose does pregnancy nausea serve?
It protects the fetus from toxins that could cause birth defects and/or miscarriage during the early developmental stages (weeks 1 - 15).
Some foods (e.g. potatoes) can be harmful to the small embryo or fetus at much lower doses than would be harmful to the mother.
What is the name of the condition where a person is incapable of feeling satiety upon eating?
Prader-Willi Syndrome
What is the one weight-loss procedure for the morbidly obese that has been shown to be effective in losing weight and keeping the weight off?
Only gastric bypass (in 80-90% of cases)
How much weight do individuals generally lose following a gastric bypass?
What disease is cured in 80% of cases following a gastric bypass?
2/3 of excess weight
Diabetes
Do patients want to make every decision themselves?
No. 64% report of surveyed individuals that if they had cancer, they would make there own choices.
However, only 12% of newly diagnosed cancer patients actually want to do so.
What is a less obvious aspect of autonomy?
Allowing patients the right to relinquish that autonomy if they wish.
In studies comparing causes of death during autopsy, were many treatable misdiagnoses found?
Yes. Even after CT, ultrasound, nuclear scanning, and other technologies have become widely available, physicians still miss the following on average (In patients that end up dying of these conditions):
25% of fatal infections
33% of heart attacks
almost 66% of pulmonary emboli
How much has the rate of misdiagnoses found during autopsy decreased since 1938?
(The number was about 40%)
It hasn’t. We still misdiagnose causes of death just as often.
Why do physicians misdiagnose?
They fail to include the correct diagnosis in their differential.
What is the derivation of the word autopsy?
“To see for oneself”
Does a child have more likelihood of being abused in a wealthy or poor home?
Poor (16x greater)
Does a child have more likelihood of being abused in a single- or double-parent home?
Single (2x greater)
