Our Medical Systems Are Broken

Our medical systems are broken. Doctors are capable of extraordinary (and expensive) treatments, but they are losing their core focus: actually treating people ~ Dr. Atul Gawande, surgeon and professor at Harvard Medical School.

 

We have now found treatments for nearly all of the tens of thousands of conditions that a human being can have. We can’t cure it all. We can’t guarantee that everybody will live a long and healthy life. But we can make it possible for most.

But what does it take? Well, we’ve now discovered 4,000 medical and surgical procedures. We’ve discovered 6,000 drugs that I’m now licensed to prescribe … And we’ve reached the point where we’ve realized, as doctors, we can’t know it all. We can’t do it all by ourselves.

We’re all specialists now, even the primary care physicians. Everyone just has a piece of the care. 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.

There’s evidence all around us: 40 percent of our coronary artery disease patients in our communities receive incomplete or inappropriate care. 60 percent of our asthma, stroke patients receive incomplete or inappropriate care. Two million people come into hospitals and pick up an infection they didn’t have because someone failed to follow the basic practices of hygiene.

There’s another sign … the unmanageable cost of our care. Now we in medicine, I think, are baffled by this question of cost. We want to say, “This is just the way it is. This is just what medicine requires.”

But I think we’re ignoring certain facts that tell us something about what we can do. As we’ve looked at the data about the results that have come as the complexity has increased, we found that the most expensive care is not necessarily the best care. And vice versa, the best care often turns out to be the least expensive — has fewer complications, the people get more efficient at what they do.

But when we look at the positive deviants — the ones who are getting the best results at the lowest costs — we find the ones that look the most like systems are the most successful. That is to say, they found ways to get all of the different pieces, all of the different components, to come together into a whole. Having great components is not enough, and yet we’ve been obsessed in medicine with components. We want the best drugs, the best technologies, the best specialists, but we don’t think too much about how it all comes together. It’s a terrible design strategy actually.

There’s a famous thought experiment that touches exactly on this that said, what if you built a car from the very best car parts? Well it would lead you to put in Porsche brakes, a Ferrari engine, a Volvo body, a BMW chassis. And you put it all together and what do you get? A very expensive pile of junk that does not go anywhere. And that is what medicine can feel like sometimes. It’s not a system.

Now a system, however, when things start to come together, you realize it has certain skills for acting and looking that way. Skill number one is the ability to recognize success and the ability to recognize failure. When you are a specialist, you can’t see the end result very well.

 

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