AHIP: Gawande, Gladwell on Healthcare's Chauffeur Problem
The changes in film and music were accepted, he said, in exchange for new opportunities to arrange, manipulate, and personalize our pictures and music. "In healthcare we don't have the same stomach for that period of transition. That's striking to me."
As an example, Gladwell offered dialysis treatment, which was first developed in the 1940s. "In every other technological marketplace there would have been a move to self-administration within the first eight years. That's the trajectory of new innovations in other industries. That hasn't happened in dialysis. The chauffeur is still there."
He noted what he termed "one lonely study" in Sweden where dialysis patients began to self-administer their treatments. Self-administration trimmed costs by 50%, and increased patient engagement and adherence to dialysis regimens.
"After 70 years this is all we have, one study. Why? Because the transition would be difficult."
Gladwell sees some hope in removing the chauffeur in new technologies such as the iPhone, which some researchers think could reduce the number of physician office visits by 70%. "But the transition will still be difficult. There will be a period of time when people will struggle with how to communicate with their provider. Things will go awry."
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