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Gawande on Cowboys and Pit Crews

Philip Betbeze, for HealthLeaders Media, July 19, 2011

One of you will be the first institution, to lower healthcare costs. It hasn't happened yet."

In closing, he offered a personal anecdote to illustrate the seriousness of the problem:

"My son was having trouble at school, and I was upset that he was stuck in a class of 30 where he was getting lost. So I approached the school superintendant after a school board meeting and asked what he was doing to lower class size. He said, 'do you know what I spend most of my time doing? Figuring out how to fight rising healthcare costs.'"

"Oh, I said. The system had a cap on taxes and so had to take from other areas to pay for healthcare. I operated on one of the teachers there for lymphoma. She's doing well, but I realized she and I were one of the reasons costs were going up so fast for the school system. The choice should not be whether my son gets enough time or whether that teacher gets great lymphoma care.

"Our job is to find that answer."

 


Philip Betbeze is senior leadership editor with HealthLeaders Media.
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3 comments on "Gawande on Cowboys and Pit Crews"


Dean White (8/2/2011 at 4:04 PM)
Dr Gawande is a star and his books have been insightful and relevant. I agree with his premise about most Cowboys but I would argue that Michael DeBakey, Denton Cooley, Sir William Osler, Ignaz Semmelweis (to name just a few) were all "Cowboys". Where would we be with the innovation and forethought of these pioneers.

Joseph Momia (7/21/2011 at 3:42 PM)
While I agree with Dr. Gawande on many things I believe he left out a crucial reason why health care costs are so high, it's the for-profit nature of the 'business'...if we adopted a Medicare for all system like Canada or any number of systems that work very well in other countries like Japan, Denmark, Switzerland, Germany, etc. all of whom provide better care for 40-50% of the cost in US. But of course in the uS we don't have a health care 'system', instead we have the health care-industrial complex where everybody tries to wring out as many $$$$ for themselves with no regard to the consequences! But the political debate won't allow this because all of our politicians are owned by the corporate whores who run this country, and they just won't use things like 'reason' and 'common sense' to solve the problems! The VA works very well for veterans and Medicare works great for most seniors and we can cover ALL Americans for much lower costs!

Phyllis Kritek, RN, PhD (7/19/2011 at 9:45 AM)
Kudos to Dr. Gawande! He is a bright light in what often appears to be a gathering darkness. I agree that checklists are invaluable. If you read his book, you learn that he discovered checklists from RNs. We understand his message. I look forward to his next tough message: the need for physicians to understand their relationship to pit crews. I have worked for over forty years with the cowboys and I know how they can destroy the good faith efforts of those in the pit crew. He is going to eventually have to tackle this challenge more directly and precisely. When he mentions an "autocratic" system, he is eventually going to have to mention who the autocrats are.