The Article by Atul Gawande (2009) New Yorker Term Paper

The Article by Atul Gawande (2009) New Yorker - Term Paper Example Some scholars suggest that the system has drifted out of control: â€Å"Through no planned design or evil intent, our health care system has evolved in ways that better serve a myriad of economic, professional, and political interests than those of patients and families, and the larger public† (Mechanic, 2006, p. ix). Gawande, however, sees a much bleaker picture, and suggests that there are areas in America where doctors and administrators are financially tied into provision, and that this encourages massive amounts of over-treatment, with no benefit to patients. Gawande’s article describes a huge discrepancy in the per capita costs of medical care in two comparable districts, McAllen and El Paso, Texas, while there is no evidence that the higher cost location (McAllen) offers better care or achieves better results. This gives rise to a serious ethical problem: in El Paso patients have much lower rates of access to all kinds of tests and treatments, while in McAllen, t hey have much higher rates. The variation is due to doctor behavior, and not down to the demographics of the citizens, since the two regions are very similar. This is the kind of situation that led to the passing of the 2010 Health Care Reform bill which aims to extend health coverage to from 83% to 95% of the legally resident population. (Tumulty, 2010, p. 1) Unfortunately, however, huge variation in the way that this money is spent will mean that a fair and equal service is not likely to happen. From the point of view of justice, or fairness, such unequal practices cannot be defended, since all American citizens should have equal access to the benefits of our modern technologies. From a utilitarian point of view, there is a deviation from best practice, since in the McAllen hospitals there is little effort to gain the greatest benefit to patients for the lowest cost. Increasing the amount of testing in order to maximise revenue is the very opposite of ethical behaviour on the part of institutions where doctors earn more for ordering more procedures and tests. Gawande suggests that the problem lies with the structures of delivery, and describes the McAllen healthcare model as â€Å"as system that has no brakes† (Gawanda, p. 14). He cites the example of the Mayo clinic, where doctors receive a fixed salary, as a potential solution. Fewer scans are done, and more discussion between doctors takes place to minimize unnecessary treatments, all of which come with risks as well as benefits, and to try to ensure that patients have what they need, rather than what can be sold to them for profit. There is little incentive to cherry pick patients in this kind of system, and hospitals which follow this style find that overall costs are lower, and quality of care goes up. This analysis takes a refreshing look at the way the whole system is set up, and this gives the reader an overview of things rather than just the view of an economist, or a health professional, or an administrator. It highlights the error that patients, and some doctors, often make, in thinking that more testing is always good. The point is to do what is the best for the patient, and not what sustains the system. If there was more of this kind of benchmarking across hospitals with comparable patient characteristics, then perhaps more could be done to eliminate wasteful

Figures of speech Essay Example | Topics and Well Written Essays - 500 words - 1

Figures of speech - Essay Example Figures of speech Style and outstanding clarity are major features of the profound speakers in the world’s history. The ultimate objective of the figures is to initiate a creative shape of the speech. The diverse figures have unique purposes within the speeches. This is evident in the subsequent analysis of Martin Luther’s speech. Diverse figures are evident in the speech of Martin Luther King Jnr. Artful repetition is a paramount technique in formulating and presenting speeches. This involves a deliberate repetition of words or phrases with an objective of clarity and emphasis. The figure of speech also minimizes the complexity of the concepts at hand. Therefore, the audiences have maximum benefits from this figure of speech. It disintegrates sophisticated details for the interest of the audience. This is an evident phenomenon in the speech by Martin Luther King Jnr. In his third paragraph, he artfully repeats the phrase â€Å"one hundred years later†. This brings an emphasis and clarity about the chronology within the hundred years of an immigrant. Therefore, he skillfully disintegrates the complexity of history and presents a simple account. Assertion is also a paramount figure of speech. This technique ensures a revelation of relationships amongst concepts of discussion. The audience always attains clarity and understanding from the comprehensive comparisons of the concepts under discussion. Under this technique, analogies are essential figures of speech. They signify particular affiliations amongst the concepts of discussion.