The Hot Spotters: Thesis

"The critical flaw in our healthcare system...is that it was never designed for the kind of patients who incur the highest costs. Medicine's primary mechanism of service is the doctor visit and the E.R. visit. (Americans make more than a billion such visits each year according to the Centers for Disease Control.) For a thirty-year-old with a fever, a twenty minute visit to the doctor's office may be just the thing. For a pedestrian hit by a minivan, there's nowhere better than an emergency room. But these institutions are vastly inadequate for people with complex problems: the forty-year-old with drug and alcohol addiction; the eighty-four-year-old with advanced Alzheimer's disease and pneumonia; the sixty-year-old with heart failure, obesity, gout, a bad memory for his eleven medications, and half a dozen specialists recommending different tests and procedures. It's like arriving at a major construction project with nothing but a screwdriver and a crane."

- From Atul Gawande's "The Hot Spotters", The New Yorker 1-24-11