Monday, April 30, 2012

Achieving Diligence

In Atul Gawande's book Better, Gawande stresses the importance of diligence in medicine. In order to illustrate this point, he profiles a recent campaign to "mop-up" polio from southern India through a large scale vaccination. I found this extreme case of diligence to be very provoking because of the great lengths these doctors had to go through to administer vaccines to a large number of children in the area. Among other logistical problems, doctors had to overcome illiteracy and compliance issues in order to execute the vaccination. For example, vocal announcements had to be made in order to spread news of the program to those locals who were illiterate.

The issue which I found the most interesting was compliance. I found it surprising that circulating rumors implying immoral intentions of the physicians were a signficicant obstacle. In this particular case, there was a rumor that the vaccine was going to cause infertility. Of course, parents were not going to allow vaccinations of their children if they believed such a rumor. How could a problem as widespread and intangible as a rumor be solved?

I thought the particular WHO doctor in this situation, Pankaj Bhatnagar, had an extremely reasonable approach towards such compliance issues. When Pankaj was confronted with a woman who did not consent to the vaccination of her children, he was not persistent or violent. In fact, when Pankaj's colleague started yelling at the woman, Pankaj instantly stopped him and explained that such an attitude would only enforce any negative rumors about the vaccine that were already circulating.

I thought this was a good way to approach diligence in this situation. Pankaj demonstrated that the achievement of diligence is not about obsessing over small tasks, but rather being persistent in trying to achieve a larger goal.

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