Ethical Dilemmas

“In this work against sickness, we begin not with genetic or cellular interactions, but with human ones (82).”  

Better, by Atul Gawande is an easy and enjoyable read. His anecdotes really made me think about certain aspects of medicine that I haven’t thought of before, such as the chapter on medical malpractice and on salaries and medical insurance. His point of view is very much the same as Groopman’s in How Doctors Think, in that he stresses that doctors must make meaningful connections with patients and look at cases individually and creatively.

The section that stuck out to me that most was when Gawande gets his first job and is asked how much he wanted as his salary. He goes through many ethical and moral questions about how much doctors should be paid. His discussions with the surgeon from an East Coast hospital, with a net income of 1.2 million, struck me the most. This surgeon looks at his profession and the health care system as a business, and doesn’t see the harm in charging large sums of money for his services that only attract those who can afford it.  Gawande says, “in this view, doctors need to understand that we are businessmen – nothing less, nothing more – and the sooner we accept this the better (123).” While, of course, we know that the health care system is a business, I find his point of view unsettling. This kind of attitude makes it seem like he’s isn’t concerned with his patients’ well being. This attitude is looked down upon in the medical world, as Gawande discovers as he asks fellow staff about their salary compensation. Many of the doctors he speaks don’t want to discuss salary, as it makes it seems as if they are in the field for money rather than to do “meaningful and respected work for people and society.” However, I also understand the surgeon’s point of view in that doctors go through extensive schooling compared to other profession. Where do we draw the line? The surgeon’s point of view on eliminating insurance companies is a complex one, in which I don’t think it is necessary to charge such large sums for his services, but like that he eliminates the middleman.

Also, as a side note, I watched his recent TED talk, where Gawande speaks about reducing errors in surgery using a simple check list system:

http://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine.html