Gawande on Cowboys and Pit Crews
"This is playing out in the political realm, and it makes it difficult to have a successful conversation about it. It descends into a yelling match," Gawande said. "There's not even agreement about the source of the problems. Is it government, for-profit medicine? I don't think these are the factors. Regulations and insurance hassles make our jobs more difficult. But they are not the root of the problem, they're the symptom."
Man's most ambitious endeavor is how to provide optimal capability without wasting resources. We have 13,600 diagnoses on how the human body can fail, we have 6,000 drugs and 4,000 possible medical and surgical procedures. While other industries have succeeded in driving down costs and improving quality, no single industry has to deliver on that many service lines, let alone do it every single time, he said.
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In fact, healthcare has become so complex, that no single physician can hope to do it alone. Part of the problem with healthcare costs and complexity is that we've built our system on the belief that the physician is the ultimate arbiter and that he or she should have autonomy.
"Five percent of the population accounts for 50% of healthcare costs. That's no surprise. They're sick," he said. "We've built our system on a structure that was built 50 years ago. This has forced us into a very difficult situation."
Gawande argues that the system should be built instead on the analogy of race team pit crews, which must function as a team, not as cowboys, who make all their own decisions. Part of this teamwork ethic can be applied in surgical checklists, a safety innovation borrowed from other industries based on the fact that no single person can keep track of all the processes that must be employed to provide optimum care.
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