How do we heal medicine? | Atul Gawande

Our medical systems are broken. Doctors are capable of extraordinary (and expensive) treatments, but they are losing their core focus: actually treating people. Doctor and writer Atul Gawande suggests we take a step back and look at new ways to do medicine -- with fewer cowboys and more pit crews.

[fmundo]

Atul Gawande has, with his work in education of physicians, has probably saved more lives than anyone else in medicine. And then there is his "must read" book "Being Mortal" which should be read by everyone who is over 60.

[KeebRocks]

"Just using a checklist requires you to embrace different values from ones we've had, like humility..."

As a final year medical student I couldn't agree more with this. It pains me to say it, but doctors are too arrogant and surgeons tend to be even more so. In fact being a bit arrogant is seen as a positive trait by many in surgery.

[MedicalStudentfor]

I first heard of Dr. Gawande during my first year of medical school in my ethics class. During this class we were introduced to Dr. Gawande and his book “Being Mortal.” I was so captivated by Dr. Gawande and his perspective on mortality in medicine. Dr. Gawande makes some amazing points on our current healthcare model. Dr. Gawande commented on the arrogance of physicians and the need for humility. Even the most specialized of physicians are not immune to making mistakes. If we can accept that physicians are not inherently perfect, we can understand the benefits of using a checklist. One principle of medical ethics is beneficence. I believe the use of checklist and interprofessional communication strategies like closed-loop communication can have a huge positive impact on patient care. The arrogance of some physicians to think they are above this is dangerous to all patients. Any policy that we put into place that increases the safety of patients should not be met with resistance, especially in the field of medicine. We have an obligation to try any and all strategies to help decrease the ever growing complexities of medicine.

[AngelCruz]

Dr. Gawande mentioned a lot of great points throughout his talk here. He hit on topics of cost of care and the complexity of medicine as it is now. One thing I really liked about his talk was he talked about the most expensive care for patients isn’t always the best care for them. I believe this to be true on most occasions and it varies in a case-by-case situation. I think some doctors don’t take into consideration that thought of cost in some of their patients’ care and that aspect is crucial for a lot patients that are hesitant in seeking out medical attention. He mentions how we must bring the components of medicine into a whole and make it work succinctly. This brought a lot of perspective for me in that, even as patients we focus on wanting the best, but it may not always work when those “best” pieces are put together for our health. The idea that Dr. Gawande implemented in with the checklist seemed odd to me at first, but seeing and understanding how crucial it can be to lowering death rates was really interesting. Something as simple as a checklist can make a huge difference for patient’s care. It’s changing the perspective that doctors have of having that self-sufficiency and independence. It is a unique aspect that Dr. Gawande mentioned of adapting a different mind set that can help heal medicine. Overall, this brings a lot of perspective as a patient and a medical student that will be treating patients in the future.

[kendallstainton]

This was a very awesome speech! I have also read Atul Gawande's book "Complications." I completely agree with it. We are too focused on doing too much, to where we make things way worse of a simple situation and stop listening to patients. So focused on this "cookbook method" where doctors are doing tests after test. Way too many cat-scans done, for issues it isn't even necessary for and just making it more expensive and more stressful for the patient. By this the patient-doctor relationship is damaged..not taking time to actually listen to the patients and listening to their symptoms inside of assuming and doing unnecessary procedures. This is a great study! To step a few steps back and focus on the basics and avoiding mistakes and even saving lives. To just go through a mental checklist and making sure everything is set. Also he is absolutely right, everything doesn't have to be this giant, grand thing, or drug. It is time again to just focus on the basics. I am surprised on how many lives this simple study has saved around the world and the crazy, ridiculous amount of cat-scans and probably MRI's have one done in one year.

[amardeepkarodkar]

One of the best Ted talk I have ever watched. Dr. Gawande is the master in medicine. He is trying to change the entire world of healthcare by doing genuine work. I am humble to you Mr. Atul Gawande. you are genius. Thank for making health care more efficient. I wish you all the best for your future work.

[adwilkin]

I never thought of healthcare this way.  I just always assumed that when I went to the doctor I was getting the best care I needed, not the best guess my doctor had. I understand that doctors are very knowledgeable and are more than likely right when suggesting tests to correctly diagnose.  I don't expect them to be right 100% of the
time but I do expect that if they don't know the answer to ask for help, not give it their best guess.  This is what
Gawande is talking about when he says hospitals need pit crews.  We need an all-round knowledgeable staff that
knows when to ask for help and not act upon what they think is correct.  Doctors have become too focused on what they believe needs to be done rather than what is in the best interest of the patient.  Performing a test that doesn’t need to be done can be costly and if the patient accepts the doctor's suggestion to do this test and it comes back negative the patient is then responsible for that cost.  Gawande states that the most expensive care isn't always the best care.  I have a friend who broke his back and the first doctor he went to said he needed surgery which was not only costly but had increased chances of complications during surgery.  He went to a second doctor and this doctor offered him an alternative to surgery which was much cheaper and had less
chance of surgical mishaps. The second doctor was focused more on the patient than on fixing the problem.  Yes, both options would have fixed the problem but the second doctor had a more patient focused mindset.  I like the idea of having a checklist that the surgeons went through for each portion of the surgery.  I wouldn't have expected to see such a drastic drop in complication rates just by implementing a checklist but sometimes the little things get overlooked when performing the same activity over and over again.  This is ensuring that the patient is getting the best care possible and that all parts of the pit crew are on the same page.  I can't believe that they are struggling to put this in place with how impressive the results were.  If each part of an office implemented a checklist to go over even just at the beginning of the day so that everyone is on the same page imagine the increased productivity.

[letsgetethical-urtm]

Dr. Gawande makes a very interesting and critical point in his TED talk when he discusses the importance of “pit crews” in every professional field, but especially in medicine. While medicine has greatly advanced over the last several decades, there are still high numbers of those that receive incomplete or inappropriate care. His implementation of a checklist that resulted in a significant drop in surgical complications and post-surgical mortality really reminded me that despite how knowledgeable and advanced clinicians have become, the basics of teamwork can get overlooked and result in poor patient care and outcome. When it comes to medicine, especially the advancement of medicine, the ethical notion of beneficence, which is the notion of “doing good”, usually comes to my mind. Dr. Gawande’s successful checklist, however, really highlights the ethical notion of non-maleficence, which means to “do no harm or prevent harm.” By implementing this surgical checklist and making sure that everyone on the team was on the same page and that small details were checked off, it made sure that no further complications were made. It prevented incomplete/inappropriate care, or harm, from happening. As this video was made in 2012, I can only hope that Dr. Gawande’s checklist has been implemented and successfully utilized in many more hospitals and medical centers across both the U.S. and world.

[ciararobb]

Humans are imperfect. They make mistakes and are inclined to have bad days due to personal, physical, emotional, or environmental things outside of their control. Relying on a group of humans to do everything right every time, simply by their memory alone is a recipe for mistakes. Using a checklist helps to eliminate human error. It is simply astonishing that death in surgery’s declined by 47% after the implementation of a surgical check list. I hope that during my career we will see checklists implemented across every specialty of medicine for every type of procedure to improve patient safety and reduce mistakes. Some physicians may see this as a burden or restrictive, but I would see it as freeing. It takes some of the weight off the health care teams shoulders, to remember everything every time and to never miss an important checkpoint for a patient. My husband is a pilot, and he loves checklists, they help him to remain safe and also help give him confidence he is not missing any crucial steps every single time he fly’s. I would argue it is unethical to be against the production of standardized evidence-based checklists for every aspect of medicine. Checklists promote patient safety, accountability, transparency, consistence, and professionalism. The only reasons why I could see a health care provider opposing well created evidence-based checklists would be a lack of humility or a unwillingness to accept health care is better when it works as a unified system. Health care is so specialized and disjointed and it causes so much heartache and confusion for patients. We need a change and we all need to work together to create safer, more efficient, and more patient centered systems.

[tarasierralee]

Brilliant, brilliant, brilliant! I've seen this before, but I have an entire new appreciation. I want Gawande to take on mainstream psychiatry and the corruption inherent in the "system" that benefits the oppressors at the expense of the oppressed. We need to do with psychiatry what he is attempting to do with surgery. HUMILITY, DISCIPLINE, TEAMWORK over INDEPENDENCE, SELF-SUFFICIENCY, AUTONOMY.

[alliewallace]

Although this talk is over 10 years old, the meaning is timeless. I appreciate how Dr. Gawande discussed so many aspects of medicine, from cost to teamwork, it was fascinating to listen to him breakdown faults in the medical system. As a current medical student, this makes me consider how I can implement checklists in my future practice to ensure things don’t go unchecked. No matter the level of knowledge and experience we acquire, it is always important to make sure the small, but important, things don’t get overlooked. As many others can probably attest, arrogance is a problem for many physicians which clearly causes a problem. The resistance to utilizing a checklist is so frustrating to me. Even with multiple examples of greatly improved patient outcomes from all over the world, physicians were still hesitant to implement new strategies in their day-to-day practice. This isn’t about our independence as physicians, this is about beneficence and non-maleficence for our patients. As Dr. Gawande stated, enacting systems and reminding those in the medical field, physician or not, that we are a part of a team and in order for the complexities of medicine to function at their best, group success is a must. This reminded me of hand-off techniques we have learned that that remind us to have good and effective communication in order to have better outcomes and less confusion. As medicine becomes more complex, our communication skills will only become more important. If we, as medical professionals, continue to allow ourselves to confront our own humility, and function with discipline and as a team, I have no doubt our patient outcomes will become better and our medical system will be more effective.

[littlemas]

Having a son with kidney failure, I will say that I have experienced both kinds of care. In one hospital people obviously did not talk to one another. At Mayo Clinic in Rochester, MN the care has been fantastic, and it is obvious that they work as a great team.

[kemchobhenchod]

the checklist manifesto is surprisingly empowering

[jnsable]

Im happy to say...the focus in family medicine in Canada in on the patient, the patients fears, expectations, goals, function of living and preferences. How many doctors continue this I dont know, but it is in the curriculum.

[MrMperis]

I am a spine surgeon and love the "Lifewings" program we have instituted at our hospital. All the surgeons and staff are on board and believe in it.

[justgivemethetruth]

Gawande is really great, read any of his books and they are so well expressed and reasoned, just fantastic and positive and life affirming.

[MARINALOVEDSK]

I already see the future if I ever land a job managing a healthcare office or dept. This speech had me thinking about all kind idea's to implement if when and that happens. I learned a lot from this video.

[medicalethics]

Dr. Gawande poses an interesting argument that the values of physicians need to change in order to promote the best care for their patients. His description of 1930’s physicians practicing with full autonomy and being involved in every aspect of a patient’s care highlights the importance of independence of the physician at that time. However, as technology has advanced far beyond the capability of any single person to know it all, the demand for physicians who can collaborate has become evident. Unfortunately, many physicians still approach medicine with the desire for full autonomy and resistance towards developing a systems-based approach to a patient’s medical care. Dr. Gawande further describes that his research has found that a systems-based approach confers superior patient care, potentially even when compared to additional training and improved technology. So why would our physicians be resistant to this change? This situation reminds me of the ethical principle of non-maleficence, a physician’s strongest obligation. For those unfamiliar with the term, non-maleficence is the ethical duty to not inflict harm or evil. While resisting adopting a systems-based approach to healthcare may not be an intentional cause of harm, it is evident that many patients are falling through the cracks in our healthcare system and are not receiving adequate care and thus harm is occurring, regardless of intention. Dr. Gawande poses a strong argument that the world of healthcare has drastically changed in the last 100 years through incredible advances in technology, and the values of today’s healthcare professionals need to change to accommodate this. There needs to be a shift from a healthcare professional valuing and acting with full autonomy to valuing and acting as a team player. Dr. Gawande’s research shows that this drastically improves patient care and outcomes, preventing unintentional harm to patients that often occurs otherwise through inadequate care caused by a lack of cohesiveness, and thus upholding the value of non-maleficence of the healthcare profession.

[varuviv]

Huge fan of Dr. Gawande. Simply brilliant!

[mpking-eyys]

His skills to solve a complex problem remind me of George Polya's How to Solve It (most mathematicians know about this). a. recognise/define a problem, b. devise a plan, c. implement it. Except Polya has another step, d. improve it.