December 26, 2016 Medical

Atul Gawande??™s book, Better, is truly an example of the struggles that people of all different walks of life must deal with on a daily basis. Gawande breaks his novel down into three different categories: Diligence, doing right, and ingenuity. The focus of my essay will be on the second section, doing right. I believe this part of the novel was the most relevant to the notion of people making errors in their judgments and actions, and how those same people can fix and learn from it them. The very title of the section, ???doing right??? is almost an impossible idea because the line between right and wrong, especially in a medical setting, can be so blurred. Doctor Gawande recalls a few stories that shed light on the painstaking world that doctors and patients can face, in regards to ???doing the right thing???. What a doctor can see as making a proper diagnosis, a patient can see as malpractice and negligence. By examining the stories that Atul Gawande narrates in the ???Doing right??? section, the blurry line can become a bit clearer to the reader.
The opening of the section explains the difficulties that doctors face when examining patients. Many different countries have different protocol for patient examinations. Clearly, there can be some nervous and uncomfortable feelings by both doctors and patients when examinations are made. For example, breast and rectal exams can be very intimidating and personal for a patient. The main point that Doctor Gawande makes is that unintended mistakes can be made by doctors for a variety of reasons. There are no clear standards in the United States for handling a patient examination. The scary stat is that, ???one in every two hundred physicians is disciplined for sexual misconduct with patients sometime during his or her career.???
Because there are no clear rules or protocol for examinations, the doctor explains some very simple rules that he follows. He explains that he is always articulate in his speech, shows decorum in his attire, and makes it a point to be precise. He also explains that, ???it is unsettling to find how little it takes to defeat success in medicine.??? The author explains that medical professionals are just as nervous and have little experience in matters of etiquette. The main idea is that though there are no perfect choices, better ones exist.
An interesting analogy that the author makes at the end of a doctor doing ???wrong??? is that of a third baseman in baseball. The best players can throw out a man almost every time the ball is hit to them. But a tiny percentage of time, they will make an error. Doctors are not perfect people. They can make mistakes and though it could be a small percent of their surgeries and diagnoses, mistakes will without a doubt occur. In my opinion, these mistakes should not be seen as wrong. Healthcare providers make extremely difficult decisions and at any step of the treatment process, a mistake can be made. Barry Lang, medical malpractice lawyer, was representing a woman who had died due to complications mistreatment of her cancer. Lang described what made a good case against a doctor in court, and he described two aspects: negligence by the doctor, coupled with damage caused by the doctor. He explained that everybody could be guilty of negligence. Not only doctors, but mechanics and accountants as well. Even people who left the oven on at home are guilty of negligence. Lang also described that, ???it doesn??™t mean you??™re a criminal.???
Another example of the blurred line between right and wrong is shown in the section, The Doctors of the Death Chamber. Executions ordered by the state have had their share of controversy over the years. It was found that lethal injections could suffocate prisoners and they could feel intense pain form the injection. This would be a breach in the Eighth Amendment of the Constitution which protects against cruel and unusual punishment. A judge ordered an anesthesiologist to determine whether the prisoner was unconscious to have the other injections. Death by firing squad could be very uncontrolled and bloody. Hanging would essentially suffocate a prisoner, but could take over a minute. In the end, lethal injection appears to be the main method of execution that satisfies the Eighth Amendment. Those medical professionals that are willing to participate in administering lethal injections are very private about their involvement.
The first doctor that was interviewed seemed to be participating because of his sense of duty to his community, because it was ???society??™s order???, and that the punishment did not seem wrong in regards to the severity of the crimes. Another doctor was told that he only had to do the pronouncement at an execution. These doctors were mostly afraid to completely disclose their personal information and general involvement because the American Medical Association (AMA) opposed physician roles in the death penalty because of their medical ethics codes. Also, patients would want their doctors licenses revoked and no longer support them. It is an extremely touchy for doctors to publicly declare involvement in. For example, one of the involved doctors had a state summon him for a public deposition on the process, along with his local newspaper printing a story. There was also a challenge to his medical license filed with the state.
These two stories of a negligence suit, along with the doctors involved in lethal injection executions, show just how difficult it can be to determine what is right and proper for a healthcare professional to do in the workplace. The negligence suit truly gives patients, healthcare professionals, and the government to attempt to come up with some kind of standard for healthcare. Many problems can obviously arise, as evidenced by Doctor Gawande??™s account. Doctors can make mistakes at any point in the treatment process. The question that arises is whether doctors should be solely responsible if something were to go wrong. The problem is that it is extremely difficult, almost impossible, to place blame on one particular individual. For example, there was a case in the novel where four years had passed before somebody recognized that a patient had a large tumor. Should the doctor who most recently examined the patient be responsible If four years had passed before anybody had caught anything, shouldn??™t they all be responsible On the flip side, if nobody had been able to recognize the tumor, then it might have been difficult to find or see in the first place. In this case, should the doctors really be punished Again, there may be too many variables for there to be a set standard on cases such as this. I believe another extremely important aspect is patient adherence. Sometimes, there can be doctors who give a proper diagnosis and treatment plan, but it is upon the patient to stick with the plan entirely. If a combination of a negligent doctor with an inadherent patient arises, who is to blame I believe as long as a doctor is doing his duty to treat a patient to the best of his ability, then he is not in the wrong. Similarly, I believe that as long as a patient is doing their best to follow through with treatment and gather as much information before making any medical decisions, then they are also not in the wrong.
In the case of the doctors assisting in lethal injections, the line between right and wrong can be very blurred as well. The bottom line is that if the state requires death by lethal injection, then somebody must administer it. Doctors who agree to participate in this act should not be seen as killers or evil-doers. This is because they are following a social duty to administer the shots. The debate over whether the death penalty as a whole should exist is another question, but to question those professionals who are doing their best to make sure prisoners do not suffer is wrong. Healthcare providers are doing their jobs, and honestly are doing something that some people may view as wrong. But doctors are not the ones handing down the orders for the execution to take place. A perfect example of why doctors should and do agree to participate in administering injections is one of the doctors that Doctor Gawande interviewed for his book. The interviewee was asked whether he was afraid of the prisoner, or was nervous, and he replied that he was not at all. He explained that it was a habit placing IV lines and administering injections. This is much better than opposed to another account that Gawande portrays of a warden preparing the chemicals himself and trying to push a syringe in that did not work. All the drugs then mixed together to create a ???white sludge???. If the government is deciding to call the order for the death penalty, then I truly believe that the doctors administering the injections should not face any repercussions for their acts. Having their licenses in jeopardy and facing ridicule by their communities is targeting the wrong person.
In the end, though there are many difficulties in coming up with a common ground or even a set standard for what is expected from healthcare providers and patients is difficult, there are better options than what are available currently. The idea should be to reduce any grey areas that exist in the system. Gawande did an excellent job portraying just how difficult this job can be, but his section title, ???doing right??? suggests that an alternative is out there for us to find.


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