There's a new TED conference video from April 2012 featuring Dr. Atul Gawande, author of amazing books including The Checklist Manifesto: How to Get Things Right.” The core of the video will be familiar if you remember my blog post on Gawande's 2011 commencement address: Dr. Gawande's Commencement Address: Cowboys or Pit Crews? It's well worth watching him deliver the message personally in this 20-minute video.
Some of my notes:
70 years ago(pre-penicillin), MDs tried to find diseases that they COULD treat, that they DID have treatments for (there were many conditions for which they could do nothing).
The core of medicine was formed in this simpler time when you could know all that there was to know, you “really could do it all.” Life as a craftsman – the culture and set of values were about being daring, courageous, independent, and self sufficient. Autonomy was our highest value.
We are now in a completely different world. We have treatments for virtually all conditions a person might not have (but not necessarily cures). What does it take?
“We can't know it all. We can't do it all by ourselves.”
Holding on to that old culture “has been a disaster.”
“We need pit crews, not cowboys.”
Looking at the high costs of healthcare, some might be making excuses of this is how is just is? But we're ignoring certain facts about what we can do to improve quality and results. We have to look at systems, not just the best collection of parts and components.
Gawande outlines the top skills required for successful systems:
- The ability to recognize success and failure (data, “as unsexy as that sounds”)
- Devise solutions (not just relying on more training and greater specialization) – “checklists are tools to make experts better.”
- The ability to get colleagues to actually do these things (it's been slow to spread)
My question – how do we get the public to DEMAND these methods that can reduce surgical harm and errors? Gawande says surgeons are resistant… when will they start putting the patient above their sense of autonomy? When we demand it? When hospitals and surgical societies demand it?
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