Few medical professionals have the same scope of influence as Dr. Atul Gawande. A writer as well as a surgeon, Dr. Atul Gawande has made it his mission to bring to light the health issues facing the public. Much of his research is inspired, at least in part, by his own experiences as a surgeon.
Dr. Atul Gawande is a practicing surgeon in Boston. Dr. Gawande went to Harvard Medical School to get his medical degree. His general surgery residency was completed at Brigham and Women’s Hospital (BWH), where he is now a general and endocrine surgeon. Dr. Gawande is also a professor at the Harvard School of Public Health and at Harvard Medical School.
In addition to this, Dr. Atul Gawande is a staff writer for The New Yorker and the author of four bestselling books. He’s also the founder and chairman of a nonprofit organization called Lifebox, which focuses on improving the safety of surgery around the world.
Dr. Atul Gawande has identified several ways to help make surgery safer.
In his book Complications, Dr. Gawande shares several surgical cases. Both patients and doctors are presented as real people. There are no clichéd or generalized patients, and the doctors are fallible and emotional. It’s a book that can give you a peek into what it means to be a surgeon, complete with odd cases, inspiring patients, and terrible mistakes.
In the book Better, Dr. Gawande again offers an insight into being a doctor or surgeon. This time, though, he emphasizes how surgeons can do a better job. Issues are presented, along with anecdotes and stories that support changes and celebrate successes. This book could easily inspire anyone (medical professional or not) to be a little more diligent and to work a little harder, but it also points out some things doctors could do to improve care – like something as simple as more regular hand-washing.
Recently, Dr. Atul Gawande has found another way to significantly improve the safety of surgery.
In his TED talk, Dr. Gawande explains that two generations ago, a doctor did everything for a patient, from blood draws to blood cultures to injections to setting bones. There were no specialists yet, because there wasn’t enough knowledge to require specialists. This, Dr. Gawande explains, led to the idea that doctors should be self-sufficient, courageous, and daring.
Now, the knowledge has expanded so much that there are dozens upon dozens of medical specialties, but that independent, daring mindset persists, as he explains:
“But holding onto that structure we built around the daring, independence, self-sufficiency of each of those people has become a disaster. We have trained, hired and rewarded people to be cowboys. But it’s pit crews that we need, pit crews for patients.”
Instead of being “cowboys,” Dr. Gawande emphasizes that doctors need to be part of a team or system. And after looking at teams of other highly-trained, intelligent individuals in high-risk occupations, such as airline pilots, Dr. Gawande saw something else that these people had that surgeons didn’t: checklists.
His book, The Checklist Manifesto, suggests and defends the use of checklists in surgery. Some of the items on the surgical checklist in the book are a bit surprising, like making sure that the surgical team has been introduced to each other by name. Reviewers of the book suggest that it has some flaws, mostly in its suggestion to utilize checklists in additional areas of medicine, but something about Dr. Gawande’s surgical checklist must work, as he notes in his TED talk:
“We implemented this checklist in eight hospitals around the world, deliberately in places from rural Tanzania to the University of Washington in Seattle. We found that after they adopted it the complication rates fell 35 percent. It fell in every hospital it went into. The death rates fell 47 percent.”
The cost of medical care in the United States has also become one of Dr. Atul Gawande’s focuses recently.
The high cost of medical care is, according to Dr. Gawande, largely due to an overabundance of unnecessary tests and procedures. Some of these unnecessary actions might be because doctors are afraid of lawsuits; they order a host of tests, just to cover their bases. Alternately, doctors might want to make more money by doing surgeries, or they might own part of an imaging company and get a part of the fee after sending a patient for imaging tests. In other cases, patients might request further imaging or procedures for their own peace of mind, even when it’s not necessary.
No matter how or why it happens, it’s clear from Dr. Gawande’s research that medical care costs are ridiculously high. Also, the cost of doing too much testing isn’t just financial. It can even affect patients’ health. The radiation from an imaging test is miniscule, but if an individual undergoes a lot of imaging tests, it may potentially increase his or her risk of cancer.
Additionally, too much testing can lead to overdiagnosis, or the diagnosis of a disease or condition that likely wouldn’t have caused any issues. Once a person is aware that he or she has a disease, growth, or the like, even if the condition isn’t likely to cause any issues down the road, it’s not uncommon to pursue treatment anyways. This can lead to all sorts of issues, like complicated, high-risk surgery for something that was benign to begin with.
When overtesting and overdiagnosis occur near the end of a person’s life, it can affect his or her final days, which is another topic Dr. Atul Gawande has been bringing attention to.
Dr. Gawande’s most recently published book, Being Mortal, explores end-of-life care. He suggests that medicine shouldn’t always be about fighting disease and putting off death. Sometimes, it should be about helping people live well. In the elderly, that might mean weighing the benefits of a procedure against its risks, or comparing a person’s quality of life with a disease to his or her quality of life when dealing with the side effects of treatment.
As in his other books, Dr. Gawande offers stories and experiences to support his stance. He also promotes the use of palliative care and hospice, rather than aggressive medical treatment, for many people. Palliative care and hospice are about making people more comfortable, relieving stress and pain, and offering support. In many instances, when a person is nearing the end of his or her life, the comfort given by palliative care and hospice can be invaluable to both the individual and to his or her family.
Pausing to ask whether or not a procedure or treatment will affect a person’s quality of life can make a big difference. Dr. Gawande encourages physicians to consider the person as a whole, rather than focusing simply on the disease, and to discuss end of life care more honestly with patients.
When considered, all of the issues Dr. Gawande discusses in his articles, books, and interviews seem rooted in common sense. Surgeons should be extra careful. Expensive testing and procedures shouldn’t be performed unless necessary. Quality of life should be valued over length of life, particularly in the elderly. Yet these common sense issues haven’t received the attention they deserve until now. By speaking out honestly and fearlessly about these issues in the medical community, Dr. Atul Gawande is attempting to improve the care given to patients everywhere.
Have you read any of Dr. Atul Gawande’s books? Which one had the biggest impact on you?
Image by Sebastien Wiertz via Flickr