Tuesday, February 26, 2019
Chapter summaries for Better by Atule Gawande Essay
Mr. Gawande starts his literature on washing pass. He introduces devil fri raritys a microbiologist and an infectious disease specialist. Both work hard and diligently against the spread of diseases except homo divisorous Semmelweis who is menti geniusd in the chapter. Some involvement I acquireed, that non many an otherwise(prenominal) a(prenominal) realize, is that apiece year two million people acquire an transmission system while they be in the hospital. Mainly because the clinicians all wash their hands one-third to one-half as many clock as they should. Semmelweis, mentioned earlier, conclude in 1847 that doctors themselves were to blame for childbed fever, which was the leading cause of maternal oddment in childbirth. The best solutions are apparently the sanitizing gels that ware only deep caught on in the U.S.Then in that location was an initiative to make the sanitizing easier for each. The take aim Perreiah came up with solutions that gave the staff mo re than time which was revolutionary in itself exclusively the format worked only under his supervision. After he left hand athletic field it all went down the drain, so, Lloyd a surgeon who had helped Perreiah decided to do more research and was excited when he encountered the positive deviance estimation, the idea of building on peoples capabilities instead of probeing to change them. The idea worked and correct got funding for ten more hospitals across the country. At the end of the chapter Dr.Gawande ponders upon the idea of how many he has infected because of his lack of cleansing. Chapter 2 The Mop-UpThis chapter starts off with the trouble of diligence. Yet there are most who have managed to deliver that arithmetic mean on an incredible scale. The task of distri besidesing polio vaccines to millions of people, many in country areas, was evidently a long and complicated task. The WHO had a team of only snows and had to teach the necessary vaccination procedures to the volunteers and local representatives, people who went limen to door in all of these areas. Their tar view for the introduction of the vaccine was 90%.It was unquestionably complicated to try to keep the supplies in a constant outpour when there were only so many. For example, the vaccines need to stay on ice to be effective.Something that conform tomed counterproductive and bother about(predicate) was the lack of information in some places. For example, some villagers didnt even know the vaccines were coming that day so they had been at sea and others blinded by their ignorance didnt want to vaccine their children. One such baptismal font conduct to a woman who ref apply the vaccines for her child but later(prenominal) went on to regret it when her own daughters legs lay limply aside. Gawande traveled with a Pankaj who made rounds checking on the progress of the volunteers and making department of corrections as necessary. The diligence in reporting gave the WHO the necessary information to learn from that mop-up. The commitment to accumulating meaningful selective information and the commitment to studying and learning from that data is righteous as important as the actual service of vaccination itself. Chapter 3 Casualties of WarCasualties of War, covers the efforts of battlefield surgeons in Iraq and Afghanistan to save as many injure in the wars as possible. A Forward Surgical squad (FST) discount set up all their equipment in the combat zones in less than 60 minutes. The travel time of a seriously wounded soldier from the frontlines back to the US averages 4 days in Vietnam, it occurred in an average of 45 days, which as any doctor knows e really indorsement is crucial. The focus of the FSTs is damage control, non definitive repair.The wounded are then(prenominal) sent on to a temporary interposition facility at one time if their injuries are serious they are then sent back to the US within a few days. The goal is for each level of treatment to give the forbearing the best chance for excerption and then hope the next step in the chain to do its part to behave on the treatment. Gawande relates the incredible story of one individual with blast injuries who was unfastened up at the FST, received sprightliness-saving surgery and had arteries tied off, then he was cleaned out, packed with ice, and sent on an air evacuation still left open from surgery with a note taped to him explaining what was done to the hot combat hospital and a new surgical team.By analyzing the patterns of injuries and treatment, other elementary life-saving measures were implemented. For example, soldiers coming into treatment were found to be without their Kevlar. When asked why? They would growl about the weight, the heat, and the discomfort. Orders were issued that Kevlar was to be taken seriously and the injuries became less frequent. Gawandes demonstrate is that reporting is vital todiligence just as it was for the WHO supe rvisor fight malaria these doctors recorded the expatiate and results of each compositors case. They understand, as Gawande writes, that vigilance over the expound of their own performance offered the only chance to do better. Chapter 4 stark nakedThe chapter is titled Naked and concerns the exam room etiquette that doctors and patients expect from one some other and often uncomfortably tiptoe around. There is an allusion to a movie that has the female person patient separated by a dark blanket like screen from the doctor. The doctors son who is about six historic period old is the communicator. Even though they are clearly audible to each other they wait until the boy speaks to them. This is the matter of decency. match to this literature some doctors feel uncomfortable with the whole work on. There is really no open up ground as to how to go about it. The author relates anecdotally that some patients and doctors predominate that having a chaperone present makes things worse.For example, when asking a female sop up to come in when a male doctor is examining a female patient makes the patient more nervous than before. The patient perhaps did not sense a cause for concern and is then put on the defensive. Most of all its about trust. The author relates occasions in which he felt aversion for the gowns but when the matters seemed to get to awkward or difficult he resulted to the exposing gowns. One out of every two hundred physicians is disciplined for sexual misconduct. Interns of both sexes on an average have had at least one incident of patient-initiated sexual behavior. So it is not strange for the fact to be more than just tricky. The chaperone helps both sides, the patient and the doctor, if any situation were to arise. Chapter 5 What Doctors OweWhat Doctors Owe, the fifth chapter of Better continues the interchange of doing right and focuses on malpractice lawsuits. The main focus of this chapter is a doctor-turned-malpractice lawyer he st ands out because most doctors hate malpractice suits. Even the lawyer says he hate them as a doctor. He said he was sued three times and two were nuisance suits with no basis, but the third was a case in which he made a checkup error which led to the harm of his patient. He appeared to feel legitimately bad about it. He argued that the system allows those who are harmed to come forward and receive some recompense which makes them better able to deal with their injury. Former Dr.Lang took up a case against Dr.Kenneth Reed for the Barbara Stanley trial.Reed had diagnosed melanoma on Barbara and insisted an extensive surgery was needed and she refused it because it seemed disfiguring to her. He got a second opinion and the tests for melanoma came back negative. 2 years later the growth reappeared. She died but not before state Lang she wanted to sue Reed. Doctors strive to care for patients as best as possible, but of course there are instances where they make honest mistakes or ar e plain negligent, and that has to be addressed because it is the patient who pays. The downside of malpractice, as Gawande argues it, is that it is an fundamentally adversarial system which pits patients against doctors against redress. He argues that it brings out the worst in all parties involved. Chapter 6 PieceworkPiecework, is on doctors pay and its inevitable connection to the health restitution industry. According to this chapter every hospital has a Master Chart of charges for every imaginable health care procedure. Everything from a checkup to a surgery is listed with the price which is later charged to a patient, which inevitably is forwarded to an insurer. This raises an interesting question because it likewise sets limits on what doctors can make. If you are paying doctors via the Master Chart, then the more diagnosis they perform, the more they are getting paid. Either that or they can charge above the standard rate. One such doctor mentioned in this chapter did j ust that. He was considered an expert in a certain field and charged nearly ten times the standard rate.He withal mandated payments in full by patients, none of this pay-through-insurance mess. He did great strain and was paid more than most doctors while doing less work. Another potential solution was attempted by a doctor-run health care concerted in Vermont. Several doctors with different specializations grouped together and charged patients a flat rate, while they took flat salaries. They were therefore able to manage the faculty of their medical care. Their network grew, and eventually they added doctors of other specializations. Eventually the co-op became one of Vermonts biggest insurers, ironic because they were trying to get away from the big insurance methods. Sure enough, size brought problems. The head and founder of the network left after(prenominal) a certain point, somewhat disappointed with the outcome. He cautions at the end of the article that at some point s oon, the apparently untenable insurance and reimbursement system will need to be changed for the benefit of doctors and patients.Chapter 7 The Doctors of the finish ChamberThe Doctors of the Death Chamber. This sections starts off with the death of Michael Morales by lethal injection. to a lower place the typical protocol the anesthesiologist administers the sodium thiopental which is expected to parry animated within a minute of the administration. Then the paralytic element is introduced, followed by a fatal dose of potassium chloride. Then later, the try on found that at least eight patients had not s chokeped breathing when the technicians gave the paralytic agent. The California Medical Association, the AMA, and the ASA immediately opposed such exponentiation in a prisoners death as a clear violation of the medical ethic codes. The author was intrigued by how the Doctors and Nurses sort between acting skillfully, acting lawfully, and acting ethically in such situations. Ever since the Gregg v. Georgia matter only two prisoners were executed by firing squad, three by hanging, and eleven by gas chamber. Pages 132 and 133 had details about the extent of each form of punishment. Some like the famed George Wallace were unlucky and had to endure physical pain for an extended amount of time. some(prenominal) doctors, even though forbidden from participating, still take part in the execution. Some will help or just pronounce the prisoner dead, either way they cant help feeling they are doing something wrong as reported by some of the interviewed doctors. They cant help but feel they themselves are the executioners. Chapter 8 On bitThis chapter is based on the fight so to say some patients have to deal with. The story of a high school history instructor is an example of someone who was willing to risk the complications of life just to be able to live it. He had a reappearing cancer in his left kidney. Through many setbacks he was last seen in a semiperma nent care facility. Despite the great advancements in his health he seemed to be in worse shape physically than before and then he was confronted with the realization that he might not be able to mountain pass ever again. Not only are they, the patients like Thomas, fighting but so are the doctors in charge.Another story about a young twelve year-old Callie had a similar reappearing tumor that came back just as big as before in spite of all the treatment. Although her family kept fighting, eventually her parents thought it was too cruel to keep Callie living such a difficult life. Many cases have been found that just by the doctors fight for a patients survival the odds get better for the patient. Many premature babies thought dead were brought back to life and were even able to live as a normal a life as possible. The summit meetingic of this chapter was Never Stop Fighting, because even when the odds are against your favor there is always that one person we wished the doctor s never stopped fighting for. Chapter 9 The ScoreThe Score starts off with Rourkes experiences as a doctor delivering babies. Then the moment comes when she herself has to give birth. She knew the process and wanted the procedure to go as smoothly as possible. The thing she was most afraid of was losing control of what was done to her. The chapter delves deeply into the process of natural endowment birth. For example, the dilation of the cervix, etc. Needless to say it is a complicated process which in consequence led to many child and young womens deaths earlier on in history. The most problematic is the exiting of the childs head. There have been many methods that can be effective if used correctly, but deadly in other situations for liberating the child. The concept of the forceps when it first appeared had been kept secret for more than a century. The device was developed by woodpecker Chamblin. The score relates to the Apgar score that was created to measure the childs chance of survival rate. This helped some cases that looked frugal before that, look hopeful. Chapter 10 The Bell trimThis chapter deals with the outliers overall. Dr. Gawande relates a story about a child named Annie. Annie was diagnosed with cystic fibrosis. It is a recessive disorder therefore, despite ten million people carrying the gene about a thousand American children are diagnosed with it per year. Her parents took her to Cincinnati Childrens and despite the hospitals effort they were negligent to say that they were not among the countrys top centers for children with cystic fibrosis. It used to be assumed that differences between doctors and facilities were insignificant. When plotting a represent of the results for each hospital it was expected to see a sharksfin but instead what was seen was a bell curve. LeRoy Mathews was at the top of that bell curve. As other hospitals adapted to Mathews ideas his facility just kept improving at a tremendous rate. In 2001 CF tried a new a pproach with its patients. They were open. They were willing to speak about how other facilities were doing versus theirs. Berwick a former pediatrician was giving grants to hospitals that were willing to try his idea. Not a single family left the program. CF improved greatly after that. Warwick was another positive deviant. He was aggressive, and inventive. He came up with a cough to be able to get the more accumulated mucous secretion out. The chapter sums up with the overall constant fight against settling for the average. Chapter 11 For accomplishmentFor Performance. This chapter sums the book up and is its own piece. It starts off with an introduction of a crack doctor of his who has CF. Then we are led to a see how a certain Dr.Motewar in the Nanded hospital deals with the mass of people needing attention and care. The man was of ordinary appearance yet he saw at least 36 patients in three hours, most had serious complications. What was surprise to the author were the man y skills developed by these doctors. He had lower expectations so to say. There was a man who died from a treatable lung collapse because of the lack of instruments.It is very common for patients to have to go out and buy their own medical instruments and medications for the procedures to be held. Dr.Motewar and his colleagues had developed a better procedure for ulcer remotion despite the conditions and lack of equipment they have. Many techniques that seem almost crude and basic were actually life saving. The doctors from which the author observed in the chapter had their own methods which would not have flown in the United States. This chapters topic was about the timeless search for a better performance in any situation you have.