In a recent article in the Fort Worth Star-Telegram Dr. David Maldonado III defends the doctors of McAllen Texas.
Let me start by saying where I agree with Dr. Maldonado.
In his New Yorker article and in subsequent articles and follow-ups Dr. Gawande extols the virtues of the Mayo Clinic model of health care. While I think much can be learned from the Mayo Clinic I do not think this model can be replicated across the United States. Dr. Maldonado has stated the reasons in his essay and I shall not repeat them here.
Dr Maldonado rightly points out that most doctors are highly skilled, hard working and want to do what is best for their patients. That has been my experience. The reality is that doctors work longer hours, endure greater stress and receive less financial reward than most other professionals. I doubt any doctor has ever come close to matching the almost half a billion dollar bonus erstwhile Lehman Brothers CEO Richard Fuld received for instituting polices that sent his bank belly-up.
However Dr. Maldonado fails to come to grips with the thrust of Dr. Gawande’s essay which is that Medicare enrolees in McAllen are subject to unnecessary procedures to the point where, on balance, the risk outweighs the benefits. Furthermore, it is not only Dr. Gawande who is making this claim. To quote Elliot Fisher again:
“…Gawande appears as the translator of what we’ve all known for a long time.”
That is, the medical establishment has known for a long time that some doctors subject patients to unnecessary procedures.
Surely Dr. Maldonado is not suggesting that doctors should supplement their incomes by performing unneeded procedures. But if he is not suggesting that then what is he suggesting?
Dr. Maldonado also fails to deal with the very real conflicts of interest, not to mention kickbacks, that Dr. Gawande’s essay revealed. Surely it cannot be right that a primary care doctor has a financial stake in a hospital to which he refers patients.
Tags: ethics, gawande, maldonado, mcallen, new yorker