Standardization resulted in good things such as neonatal intensive units, prenatal ultrasound, obstetrics package. “And that package has produced dramatic results”.
Gawande highlights some flaws of Obstetrics such as their lack of double blind, controlled randomized trials (obstetrics uses the least double blind controlled trials in all of medicine), use of fetal heart rate monitoring device, forceps eliminated even though better for mothers Gawande though absolves them of blame because they are so successful at saving lives. Gawande even complements obstetrics for not relying on clinical trials, but trying things on the fly. Even admits that it is unclear whether many aspects of the obstetrics package are beneficial. Gawande seems to be satisfied that obstetrics is saving lives, not concerned that there are some alarming practices that could be improved. Because Obstetrics still is concerned primarily with safety, “reliability [is chosen] over the possibility of occasional perfection”. Gawande postulates whether medicine is a craft or industry, with craft being about perfection, and industry being about safety and reliability. Gawande’s view is black and white, should be a craft where if you can do forceps you do that and you perfect c-section if you can do that. Gawande’s view leads to a reliance in c-sections. A system could easily be developed in residency to deem wheter obstetricians are ready for forceps to allay Gawande’s concerns about inexperience.
Despite Gawande’s misguided desire for standardization and reliability, Gawande’s agpar for mothers after surgery is a step in the right direction because it will push doctor’s to achieve perfection and foster innovation.
Incrption devices. Fetal heart monitors are essentially inscription devices, but instead of producing diagrams and charts, it leads to unneccesaey c-sections.
Gawande constructing authority
Capturing other’s interest of...