Medical care from the ground level

Some of the same messages as those in Atul Gawande’s “Cross Conundrum” article from a year ago, but compellingly  told from the viewpoint of a patient’s family member:

I believe that my father’s doctors did their best within a compartmentalized and time-pressured medical system. But in the absence of any other guiding hand, there is no doubt that economics helped shape the wider context in which doctors made decisions. Had we been at the Mayo Clinic – where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor – things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.