Thursday, June 18, 2009

Do you really want to improve healthcare? You do it as a doctor by not settling for anything but the best outcome

Atul Gawande wrote a 2004 article in the New Yorker that was a stunner. I thought cystic fibrosis patients died around thirty years of age. Turns out they don't have to. At one cystic fibrosis clinic in Minnesota, patients hardly ever die. How was this achieved? It took a doctor who was absolutely compulsive about getting the very best outcomes. He just kept trying things and working harder and pushing everyone else harder too. He didn't just keeps repeating the practices in the textbooks.

Medical culture is one of complacency and uniformity. Malpractice laws require that we practice according to a local standard. You want to try something different? Stepping outside the mainstream makes you more susceptible to losing a malpractice suit. It usually makes your colleagues uncomfortable, too. If the local standard amounts to doing every test and procedure in the book---well, that is what you are expected to do, actually it is what you are legally required to do.

But if we want stellar outcomes, not to mention cost savings, that is absolutely the wrong way to get them. Gawande's articles are game-changers.

What we need is a paradigm shift. We have to make sure everything we do, for every patient we see, uses every arrow in our quiver to aim for that perfect outcome. And we have to use data and science a lot more, to make sure we know what works to achieve those results. We have to train docs to think differently.

The demand that doctors practice at the level of a local standard probably makes sense as a legal doctrine. But it sets the bar for healing way too low. It's basically a race to the bottom.

Gawande shows us exactly the kind of cultural shift that could truly achieve the world's best healthcare system. If you read nothing else on improving healthcare, READ THIS ARTICLE.

1 comment:

lewweinstein said...


I agree with you. I thought Gawande's New Yorker article was as good as anything I've read on the topic. I posted excerpts to my political blog ...’t-first-understand-the-problem/