Atul Gawande: evaluation

Transcript context

…Do you ever worry that doctors become corrupted by their own authority? Not corrupted in the sense of taking bribes, but they have such authority, people look up to them. They say “Take off your clothes, sit on the table.” People do it—people are in the mode of obeying. A lot of patients, frankly, are probably a pain, so doctors in a sense can manipulate patients to make each interaction easier because they’re such high-status figures. And then doctors fall into this mode of being used to doing that with people in general. What do you think are the main psychological dangers of corruption that can stem from being a doctor and having such high status? Control over life or death. “You can cure people, the gods cannot.” That’s what Sir Thomas Browne said, right? [laughs] I think that the health system of every country is a demonstration of our corruptibility. Kenneth Arrow’s 1960s essay on asymmetry of information used healthcare as its prominent example that sellers are more powerful than buyers when we not only control the decision set, we control the option set. And the opportunity and ability of the individual to understand all of those, to be able to make choices among them, is hindered especially when you are sick. The most powerful tool that a clinician has is their pen, and has the power to order medications to test, to doing an operation. So yes, the power . . . Look, it’s an unusual profession in that yes, we can ask you to sit on the table and make yourself the most vulnerable in the most vulnerable way possible—not only to ask you to take off your clothes, but then to actually have permission to cut you open and do what I choose to do inside you. That is a tremendous power. And the ways in which we see that just the payment incentives alone dramatically affect whether my tendency is to give you overtreatment in certain situations and undertreatment in others, is a reflection of our failure to follow through on being able to deal with the variability in that, and how we use that asymmetry of information. A lot of critics have charged that to get a new drug through the FDA, it takes too many years and too much money, and that somehow the process should be liberalized. Do you agree or disagree?…

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