Time magazine calls him “One of the world’s top 100 thinkers.” And thanks to my brother Gordon, I got to hear Dr. Atul Gawande speak at this year’s Maine Quality Counts annual conference, along with 1,200 others who were packed into the Augusta Civic Center. It may have been the best speech I’ve ever heard.
Dr. Gawande is the author of three bestselling books: “Complications,” a finalist for the National Book Award; “Better,” selected by Amazon as one of the 10 best books of 2007, and “The Checklist Manifesto.” He is a surgeon at Brigham and Women’s Hospital in Boston, a professor at Harvard Medical School, and director of Adriadne Labs, a center for health systems innovation.
Dr. Gawande has a very comfortable, personal, and persuasive way of speaking. He took us through the history of medical care and then focused on today’s “underlying problem — the complexity of delivery of health care.” And he recognized “the most ambitious thing man has ever tried to do — bring this knowledge and care to every person alive.”
Over the last 75 years, we’ve figured out 60,000 ways the human body can fail, created 4,000 medical and surgical procedures, and developed 6,000 different drugs and thousands of ways to prevent illness, he told us.
He talked about the fact that we’ve built a system that has silo’d every part of health care, with a specialist for every part.
And he personalized it, talking a lot about his father and mother.
His mother had knee surgery and 63 professionals called on her in her hospital room. Sometimes the experts even disagreed. But after she left the hospital, she saw only one professional in six months — for 15 minutes.
“We need a pit crew for patients,” he noted. “A large number of patients are getting incomplete or inappropriate care. It’s like no one’s in charge. We have amazing people, the smartest, best trained, hardest working — with amazing technology — but it’s not working. And the cost has become unmanageable.”
Well, this was just in the first few minutes of his speech. I took five pages of notes. He reported that there is no connection between the highest prices and the best care, and noted that Maine — for Medicare patients — is in the top 25 percent for results and the lowest 25 percent for costs.
“But we don’t really know how Maine got there,” he said. “This does mean that there’s hope of marrying lower costs with the best care.”
I was pleased and proud when Dr. Gawande reported that states like and including Maine are part of a broad 10-year effort to improve health care quality, prevent chronic diseases, track hospital infections, empower patients, and lots more.
“If the rest of the country were like Maine, we’d have probably hundreds of billions of dollars available for everything from infrastructure and education to health,” he said.
As Maine goes, so goes the nation?
He went on to describe what a good health care system looks like, including data-driven results to show where we are succeeding and appropriate end-of-life care (including palliative) based on the patient’s goals.
Right now, “We don’t ask them,” he said. And he reported that we spend more time tracking the health of our cows and crops than ourselves.
That was very sobering. He could have added dogs and cats to the list, probably.
“We’re obsessed with the components of health care,” he said. “We want the best drugs, devices, doctors, and specialists (but) we don’t think much about how we put them together.”
Throughout his talk, Dr. Gawande brought these issues and problems down to our level, with personal stories and great analogies.
This was one of his best: “Imagine constructing a car with the very best parts — Porsche brakes, a BMW chassis, a Ferrari engine, and a Volvo body. You put it all together and what do you get? A mess. A very expensive mess that does not go anywhere.”
But towards the end of his amazing talk, Dr. Gawande lifted our spirits by telling us, “This is the best time to be alive, for your health.” Good to know.
On my way out of the Civic Center, I purchased a copy of Dr. Gawande’s new book, “Being Mortal.” The subtitle is Medicine and What Matters in the End. The jacket claims it’s a “book that has the potential to change medicine — and lives.”
I have read the book and can report it is all of that. And next week, I will tell you all about it.