Checking America’s Pulse with Malcolm Gladwell

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Checking Americas Pulse

• Malcolm Gladwell Discusses
  Health Care in America with Forbes

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In Malcolm Gladwells latest book David and
Goliath, the New York Times bestselling author
applies the fable of the man versus the giant to
todays social structures and institutions, and
in one instance, a single physician attending to
children suffering from a deadly type of leukemia
versus the set medical structures.
In the end, the physician bucked the notion that
his lack of authority made him disadvantaged, but
rather, gave him the firsthand experience to
develop a successful treatment for childhood
leukemia.
Malcolm Gladwell
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The Interview
With the release of his book, Malcolm Gladwell
sat down for a rare interview with Forbes
contributor Robert Pearl to get his take on
health care in America. Known for his astute
insight into society, politics, and government,
Gladwell did not disappoint with views covering a
wide range of topics on the intricacies that make
up American health care. Here are the highlights
from the interview.
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The Affordable Care Act
Gladwell comes out the gate stating his feelings
about the Affordable Care Act are mixed, in that
he believes the Acts intentions are in the right
place, however, he is concerned if this is the
right approach considering Americas many
challenges with health care delivery.
Gladwell suggests a system that values innovation
for health care delivery. This type of
innovation, he points out, would have to start at
the bottom.
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• When it comes to Americans maintaining good
  health, Gladwell sees the issue as twofold
• There are very few incentives in the current
  system to motivate people to live more healthily.
• There are also few incentives for physicians to
  encourage healthier lifestyles to patients in a
  fee-for-service model.

KNOW THE FACTS 34.9 percent of American adults
are obese, according to the Journal of American
Medicine. Conditions relating to obesity, such
as heart disease and stroke, are prevalent causes
of preventable death, states research from the
National Heart, Lung and Blood Institute.
As Gladwell sees it, the government is in the
position to cultivate a system that makes healthy
living easier and puts the focus on preventative
measures.
Americas Health Habits
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The High Price of Innovation
Gladwell believes its hard to compare American
health care to other systems, such as his native
Canada. The U.S. has the unique position of being
an advanced medicine pioneer, which comes with a
high economic burden for developing such
technology.
Gladwell also points to Americas social dynamics
that need to be considered within the system. A
country with a large standing army, and violent
past, America has an obligation to properly serve
its veterans, as well as incorporate the
underclass into the health care system.
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The Malpractice System
Gladwell suggests the current malpractice system
does not adequately serve the people involved
since errors are often directly related to the
delivery of health care, not just the individual
physician. His solution? Gladwell suggests we
better compensate those who suffer from errors
and address the breakdown in the system as a
whole, not just the singular error by any one
individual.
KNOW THE FACTS According to a study in the New
England Journal of Medicine, by the age of 65,
nearly a hundred percent of physicians in
high-risk specialties had faced a claim of
malpractice for low-risk specialties, it was
estimated at 75 percent.
KNOW THE FACTS Not just open heart surgeons are
subjects of malpractice claims, psychologists and
psychiatrists are susceptible too. A forensic
psychiatrist may be called in as an expert
witness or consultant in claims of
psychotherapeutic or psychological/psychiatric
malpractice.
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Government Regulations
Gladwell sees government regulations as strong in
some areas, and over-bearing in others. He points
to the stringent regulations for nursing-home
care and says the care is still not substantially
good. It could be, he says, because the human
element the compassion is being squelched
under all the regulations.
On the other hand, he points to regulations
within pharmaceutical manufacturing, which he
says should be voluminous in detail and not left
to any one individual's discretion. The process
should be streamlined and factories must be
inspected and investigated routinely.
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In discussing care over a lifetime, Gladwell says
individual needs and type of care considering the
patients age and overall health should always be
examined.
Gladwell describes end-of-life care focusing on
dignity, compassion, and attentive nurses, while
the focus on a young person in a car accident
would be a much more aggressive approach. One
way to look at it is, different resources and
practices for different stages of life. For
example, aggressive interventions may not be in
the best interest of elderly patients who have
long since suffered from a multitude of ailments.
KNOW THE FACTS According to a study in the
Journal of the American Medical Association, the
percentage of Medicare beneficiaries who died in
hospice from 2000 to 2009 substantially increased
from 21.6 percent to 42.2 percent, respectively.
Living with Dignity
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Image Attributions
Slide 2 Image courtesy of Pop!Tech and Kris Krug
through Flickr Creative Commons https//flic.kr/p/
5wds2h
Sources
All Slides Forbes interview by Robert
Pearl http//www.forbes.com/sites/robertpearl/2014
/03/06/malcolm-gladwell-on-american-health-care-an
-interview/ Slide 4 Obesity statistics http//ww
w.cdc.gov/obesity/data/adult.html Slide 6
Malpractice statistics http//www.ncbi.nlm.nih.gov
/pmc/articles/PMC3204310/ Slide 8 Hospice
statistics http//jama.jamanetwork.com/article.asp
x?articleid1568250
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Summary
With the release of his latest book, Malcolm
Gladwell sat down with Forbes to discuss a range
of topics on American health care, including the
Affordable Care Act, the malpractice system, and
end-of-life care. These are the highlights from
the interview.