Malpractice by Lawrence Schlachter

Author:Lawrence Schlachter [Schlachter, Lawrence]
Language: eng
Format: epub
ISBN: 9781510712591
Publisher: Skyhorse Publishing
Published: 2016-07-15T04:00:00+00:00

CHAPTER 12

Why Dr. Codman Got Fired

There are very good reasons why we refer to the big picture as “health care” and not “disease reduction,” “pain alleviation,” or “organic technologies.” The big picture is about achieving, maintaining, and, when possible, recovering good health. This is about more than just the doctor, the hospital, the nursing staff, the treatments, procedures, surgeries, and possible interventions. The discussion is and should be framed as health-centered, not disease-centered, and certainly not procedure-centered or treatment-centered. The goal is to bring the patient back as effectively and quickly as possible to a state of whole health as is reasonably possible for that particular patient.

This is a paradigm shift for some, and unfortunately, by some metrics, it seems we are moving in the wrong direction. Procedure/treatment-centered health care is practitioner-centered, not patient-centered. Practitioner-centered medicine is about process, productivity, profitability, prestige, and, sometimes, personal power. It loses sight of what is needed to return this patient to her optimum state of health, but focuses instead on what procedures could or should be initiated that may not necessarily do any good, but will probably not do any harm or make the patient worse off, and will enhance the numbers for the practitioner or institution that employs him.

If we are concerned about health recovery, what are the benefits and risks of pursuing medical interventions, and conversely, what are the benefits and risks of not implementing them? Patient-centered care means taking the time to encourage patients to tell us the full story, because the detail they leave out may be the key to successful diagnosis. It takes time to thoroughly explain options to patients and their family members in language they can understand.

Dr. Ernest Codman fully grasped the concept of health care well ahead of his time. Codman graduated from Harvard Medical School in 1895 and developed a reputation as an excellent orthopedic surgeon. However, Dr. Codman’s greatest contributions to health care came from his focus on systemwide reform centered around delivering better care.

Concern for a patient’s prospects for returning to good, or at least better, health was critical to Dr. Codman. He was not a conveyor-belt doctor, and he wanted to know what happened to patients after they left his clinic or hospital. He wanted to know whether his treatments had been effective, in a more global, big-picture sense. In other words, he was interested in outcomes. Long before Stephen Covey wrote his bestselling book, The 7 Habits of Highly Effective People, Dr. Codman “began with the end in mind.” Like any dedicated health-care practitioner, the “end” was not his income, his authority, or community status. It was not about him. Dr. Codman was patient-centered, and the “end” for him was the return to wellness of the patient.1

Like many doctors, during his schooling and practice, Dr. Codman noticed that not all doctors are equal, that not all are competent, and that frankly, some should have found something else to do for a living. He noticed that it was easier to get

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