Big Med
A response to: Gawande, A. (2012). Big Med. The New Yorker. Retrieved September 7, 2012 from: http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande
In our current political and economic climate, there is no denying that some of the most divisive issues surround how to mitigate the rising cost of healthcare in this country. Our healthcare providers have struggled to balance financial responsibility and efficiency with the amorphous urge to “do the right thing” by their patients, but how does that look on a national scale as the number of patients with significant, chronic illnesses continues to increase exponentially?
Dr. Atul Gawande, in the August 13th edition of The New Yorker, posits that there are undeniable and basic ways in which efficiency and standardization have a place in the doctor’s office. Dr. Gawande takes his inspiration from perhaps the least imaginable of places: The Cheesecake Factory. His article, “Big Med,” is a well-written and truly thought-provoking look at the ways in which we, healthcare consumers, incorrectly assume that certain practices in medicine are already made standard. Dr. Gawande asks, “Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?”
Instinctively, the idea of comparing the provision of healthcare to the operation of a restaurant chain is likely to fall flat, perhaps even offend. Upon further examination, however, some aspects of his argument are mere common sense.
Dr. Gawande argues that the larger health systems—which have overtaken the role traditionally held by private physician practices—are indeed the ideal arenas in which to both standardize care and measure its impact. One powerful section of this article discusses the advancements trialed by Dr. Armin Ernst, a physician responsible for intensive care unit operations at a system of ten for-profit hospitals. “Ernst…is a doctor, a new kind of doctor, whose goal is to help disseminate good ideas. He doesn’t see the I.C.U. as a doctors’ workshop. He sees it as the temporary home of the sickest, most fragile people in the country.” The chilling implication here is that, despite the complicated needs of these fragile people, there are standard, research-driven approaches to their care that are not being followed ritualistically.
Dr. Gawande concludes that there are many factors that play a part in the provision of effective care:
The role of technology in a quest for quality:
- Great clinicians make simple mistakes/oversights too
- Good healthcare involves a system of checking others’ work (not for punitive purposes)
- Virtual quality control is provided in some I.C.U.s via video monitoring
- Restaurants have software that “predicts” the future needs of their customers based on patterns – would this idea have a role in healthcare?
How can we balance our wishes to receive personalized healthcare with the recognition that we need to be good stewards of our resources?
How will physicians respond to this approach?
Teamwork: one of Dr. Gawande’s primary observations is that efficient healthcare is provided by teams of clinicians:
- Surgeons, nurses, physical therapists. Etc.
- Successful teams have in-synch medical philosophies, informed by a significant evidence base
Dr. Gawande does not argue that we should receive healthcare as though we are identical robots, rather that there are ways in which we can standardize aspects of care. The sooner we consumers can shake the perception that the best care is customized to our specific needs 100% of the time, the better. We live in a society that honors individualism, but occasionally are humbled to recognize that standards of care are informed by broad-based research.