http://www.fpamed.com/ | 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.

1. Checking America’s Pulse
Malcolm Gladwell Discusses
Health Care in America with Forbes

2. In Malcolm Gladwell’s latest
book David and Goliath, the
New York Times bestselling
author applies the fable of
the man versus the giant to
today’s 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

3. 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.

4. The Affordable Care Act
Gladwell comes out the gate stating his
feelings about the Affordable Care Act
are mixed, in that he believes the Act’s
intentions are in the right place,
however, he is concerned if this is the
right approach – considering America’s
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.

5. 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.
When it comes to Americans
maintaining good health, Gladwell
sees the issue as twofold:
1. There are very few incentives in the
current system to motivate people
to live more healthily.
1. There are also few incentives for
physicians to encourage healthier
lifestyles to patients in a fee-for-service
model.
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.
America’s Health Habits

6. The High Price of Innovation
Gladwell believes it’s 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 America’s 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.

7. The Malpractice System
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.
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
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.

8. 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.

9. In discussing care over a lifetime, Gladwell says individual needs and type of
care considering the patient’s age and overall health should always be
examined.
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.
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.
Living with Dignity

10. Contact Us
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11. 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://www.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.aspx?articleid=1568250

12. 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.