Healing Medicine

We all know that the US healthcare system is in need of a little healing. Surgeon and health policy journalist, Dr. Atul Gawande, addressed this topic during a recent TED Talk.

Dr. Gawande provided several points that were applicable to primary care practices on a Patient-Centered Medical Home pathway. Here are some noteworthy points from his presentation:

Medicine and Complexity

Dr. Gawande explained that today’s healthcare is much more complex than it was even just 30 or 40 years ago. There are over 4,000 medical and surgical procedures and over 6,000 drugs that can be prescribed. That’s a lot for any one health care team member to manage.

Medicine and Money

Today our world can boast some of the best trained doctors we’ve ever seen, but does that translate into the best care? He points out that 40% of patients with coronary artery disease are not receiving the care they should and neither are 60% of patients who experience either asthma or stroke. Over 2 million people who enter hospitals leave with an infection they didn’t have when they arrived.

Fortunately, we are studying health care so we can know what translates into the “best” care. The good news? The best care isn’t linked to the most expensive care. So what’s the bad news? (There’s always bad news, right?) The best health care is based on systems. That means health care teams working together. That’s not something that comes easily to a typical independent-natured physician. Rather than cowboys in healthcare, Dr. Gawande says what we need are pit crews.

System Skills

Dr. Gawande recommends that healthcare systems adopt 3 skills to improve care delivered.

  1. The ability to recognize success and failure. That means becoming more focused on data, which is not an easy thing in medicine today. He referenced a physician in Cedar Rapids, Iowa, who decided to get a better grasp on how many CT scans were being conducted. It took over 3 months to get at the data, but finally they discovered that out of a city of 300,000 people, 52,000 CT scans had been conducted the previous year alone.
  2. The ability to create solutions. His team was asked by the World Health Organization to find ways to reduce the number of deaths as a complication of surgery. To find solutions, they looked to other industries and found something as simple as checklists. They developed a surgery checklist that focused on all members of the teams and included steps as straight forward as introducing each member of the surgery team before beginning work that day.
  3. Finally, a system needs to be able to implement solutions. Dr. Gawande implemented his team’s surgery check list in 8 hospitals around the world and they found the complication rate fell by 35% and that the death rate fell by over 40%.

Conclusion

One thing we know today is that the craft of medicine requires more knowledge. Out of the tens of thousands conditions that can afflict humans, there are now treatments for most all of them. That doesn’t always translate into cures, but there are at least informed decisions that providers, their team, and the patients can make.

More knowledge comes at a cost though. That’s because knowledge brings about complexity.

Complexity requires a shift from individual strategies to group success. Dr. Gawande ends his inspiring talk by saying, “We all need to be pit crews now.”

 

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