The Bell Curve, an article published in the New Yorker a few weeks ago, is an eye-opening look by surgeon Atul Gawande at what's really going on in terms of physician competencies--and he finds a big bell curve, with a few supremely competent and supremely incompetent on either end, and the vast majority being mediocre. Gawande also thoughtfully explores what makes the excellent excel--and it flies in the face of everything we think we know about evidence-based medicine. The physician bloggers have had a lot to say about it as well.
For example, A Chance to Cut is a Chance to Cure concludes that, "We should strive to improve ourselves, to narrow the gap between 'average' and 'excellent' so that is insignificant." (And check out the comments on his post--very interesting!) MedMusings delves into the "art of medicine" vs. evidence-based:
"On one hand it points to the importance of pushing the therapies with the best evidence backing it up, but on the other, the fanaticism that it takes to provide care that optimizes the outcomes beyond what can be expected from following guidelines.
For me, what i took away from the article was not that i need to espouse extra-canonical treatments, but that i really need to care deeply about my patients, and elicit as much honesty from them as possible.
How do you teach that level of caring, not just care, in CME? There's a kind-of-related post on this at The Cheerful Oncologist, who concludes a discussion on pain management with, "Pain consumes a person's spirit and wraps itself around the waking mind like iron chains. It robs the sufferer of the ability to accomplish tasks, or even interact with loved ones. Pain is evil. Having written this, I shall pledge to always remember what it was like to be in pain, as I pledge to remember what the good men and women in my care are going through on this day, and the many evenings to come."
For more related to this topic, read the article referenced in Anne's post earlier today.
The Bell Curve, an article published in the New Yorker a few weeks ago, is an eye-opening look by surgeon Atul Gawande at what's really going on in terms of physician competencies--and he finds a big bell curve, with a few supremely competent and supremely incompetent on either end, and the vast majority being mediocre. Gawande also thoughtfully explores what makes the excellent excel--and it flies in the face of everything we think we know about evidence-based medicine. The physician bloggers have had a lot to say about it as well.
For example, A Chance to Cut is a Chance to Cure concludes that, "We should strive to improve ourselves, to narrow the gap between 'average' and 'excellent' so that is insignificant." (And check out the comments on his post--very interesting!) MedMusings delves into the "art of medicine" vs. evidence-based:
How do you teach that level of caring, not just care, in CME? There's a kind-of-related post on this at The Cheerful Oncologist, who concludes a discussion on pain management with, "Pain consumes a person's spirit and wraps itself around the waking mind like iron chains. It robs the sufferer of the ability to accomplish tasks, or even interact with loved ones. Pain is evil. Having written this, I shall pledge to always remember what it was like to be in pain, as I pledge to remember what the good men and women in my care are going through on this day, and the many evenings to come."Anne's post earlier today.
