Big Medicine may be a big mistake

Bigger isn't always better.

Dr. Atul Gawande concludes in his New Yorker article that, "The Cheesecake Factory model represents our best prospect for change."

Is this the world where we live now? Chains are our wave of the future? Is this the type of innovation that you are looking for?

The article raises important issues regarding raising the quality of care in hospitals -- not medical care. Much of the problems outlined in the article are not about the orthopedic surgeon picking the wrong prosthesis, but the surgeon picking a prosthesis that was too expensive; other quality issues revolve around the attitude of the support staff.

It is hard to understand how big chains are going to improve this when we already have ample examples of poor service at major national hospital chains.

While some medical processes are being standardized, others don't lend themselves to this. For example, every neurologic patient is unique -- not at all akin to the chickens being prepared for Cheesecake Factory patrons. Chain hospital administrators will try to streamline neurologic care, much like thy do for knee replacements. This won't solve anything -- instead it will encourage the type of 2.5 minute neurologic examination described in the New Yorker article.

The solution is for Medicine to step up and to police itself and to use the time honored traditions of placing our patients first, educating ourselves throughout our lives and of educating the next generation of excellent American doctors.

Daniel Kantor, MD
President
Florida Society of Neurology