Wednesday, February 16, 2011

Power Players: Atul Gawande

Medicine is a curiously antiquated discipline. While the information revolution continues to transform nearly every field of knowledge, the realm of medicine remains largely set in its ways. That we finally have an outspoken physician-intellectual willing to confront this uncomfortable fact in the form of Atul Gawande causes me a great deal of internal dissonance.

Gawande--a surgeon, professor, and author based in Boston--is unequivocally providing a great service to the public and to policymakers by bringing his personal experience and creativity to bear on this important issue. But the other, more thoughtful side of me weeps at the simple fact of his existence and what it implies about the contemporary world of medicine.

Although a regular contributor to the New Yorker Magazine on many health-policy issues, Gawande is probably best known for his most recent book, The Checklist Manifesto: How To Get Things Right. In it, Gawande argues that the mundane checklist can be a powerful tool for simplifying the complexity of the world and, in the context of medical procedures, save lives. Checklists ensure that mundane but critical details (like hand-washing) don't get overlooked and that coordination occurs between stakeholders. [watch Atul Gawande describe the idea here].

Using a checklist in all medical procedures certainly seems like a good idea, and the praise heaped on Gawande's book is certainly well-deserved. But... a checklist? Really? That's the exciting, cutting-edge macro-trend sweeping the world of medicine!? Clearly there's more to this story than just a simple checklist.

Most economic sectors are rapidly shifting to computer-aided quantitative and statistical analysis as a method for generating knowledge. This replaces the old intuitive, experiential forms of knowledge (e.g. the venerable "expert", with decades of trial-and-error wisdom) that were unreliable. A while back, the cold statistical logic of randomized trials stripped physicians of their power to discover which solutions work and which ones don't. Increasingly, diagnosing medical problems is a job for computer algorithms. Yet, in many vital areas of medicine, such as surgery, this change hasn't happened. Physicians' individual intuition still holds holds tremendous clout. In this context, Gawande's checklist is simply another mechanism through which rigorous, data-driven knowledge is replacing experiential expertise.

Gawande's willingness to critically examine his own organizations and institutions is refreshing. Although medicine is at the back of the pack in eschewing unreliable experiential expertise, it's headed in the right direction. Now law on the other hand...

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