Atul Gawande’s prescient 2012 TED talk

Health care is buzzing as Atul Gawande has been selected as CEO of the Berkshire-Hathaway/Amazon/JP Morgan strategic venture. I was thrilled they picked a physician, like myself, in the trenches to run their gig. After hearing the news, I remembered Gawande’s TED Talk from 2012 and decided to catch up on it during my flight to the Healthcare Finance Management Association Annual Meeting and Innovation Lab.

After watching the talk, “How do we heal medicine,” it occurred to me that while Gawande is a forward-thinking surgeon with good ideas on how to disrupt the systems of health care, he is a doc who has focused mainly on the sickest of patients. This doesn’t seem too disruptive since most of the spending in health care is focused on these patients already. Hopefully his experience in public health will guide his focus more upstream, providing the perspective we need to make an impact on spending. It will be interesting to see how he applies “Primary Prevention Thinking” to the Amazon/Berkshire Hathaway/JP Morgan Model. Amazon, Berkshire Hathaway, and JP Morgan Chase employees need to be healthy in order to work.

In his 2012 TED Talk, he talks about our history and how we are still training new physicians through the lens of a 1937 practicing physician. He describes in excruciating detail what little they could actually do for patients at the hospital bedside. Traits of individualism, self-sufficiency and autonomy were the cherished traits of the time. I would agree with him, from my time in residency, that these strategies were used even in my own training in the 90’s. Knowing what to do in the moment when a patient is in trouble, taking charge during a code, being at the bedside in a moment in which a patient is in pain or in need; this is how our hospitals were run and how they still are.

Gawande points out that the explosion of science since those 1937 admissions has resulted in an advancement of not only treatments, but complexity to our health system.  As he finishes his talk, he places the burden on each of us working in health care:

Making systems work is the great task of my generation of physicians and scientists… In every field, knowledge has exploded, but has brought forth even more complexity and specialization. We have no choice but to recognize the fact that this complexity requires group success.  We all need pit crews.

In the words of the Harvard-trained surgeon, “In the U.S. we want the ‘best’ drugs, the ‘best’ technologies and the ‘best’ specialists. But we don’t think too much about how it all comes together. “

He gives a funny analogy: take a Volvo body with a BMW trunk and a Porsche chassis and what do you get? A very expensive pile of junk that doesn’t go anywhere.

Though he admits, “Sometimes the best care is the least expensive care.”

A surgeon after my own pediatrician’s heart.

He points out that the traits at the core of our roles are “independence, self sufficiency, and autonomy.” But these do not work well within a system. In order to implement his famous surgical checklist, the value system has to be different. People need to embrace different values.  He explains the values necessary in a system are “ teamwork, humility, and discipline.”

He says in order to make health care work, we need to work within systems. The use of digital health is an opportunity for providers to utilize tech-enabled behavior change interventions in their medical practice. It’s an opportunity to harness technology and teamwork to improve health outcomes. As physicians we need to leverage our teams to implement and reinforce the recommendations we offer in the office.  We need to leverage partnerships and collaboration to use technology in order to actually reinforce the health behavior changes we are trying to communicate to our patients. The patients themselves are an essential component of our team and should be positioned at the center of everything we do.

Humility is an important trait for providers.  We need to realize that times have changed. The rules have changed due to reform.  As providers, we need to adopt a level of humility if we want to stay in the game of medical practice, whether it is in hospital employment or private practice.

We need to adopt the discipline to look at the data of our practice/claims/outcomes/pertinent risk scores and find partners to help us take action on that data.

We want to empower our patients to be self-sufficient and to self-manage.  We want our compensation to be reflective of our efforts and desired outcomes.  Those of us in primary care want to capture our patients needs earlier in the disease spectrum, which will allow us to help them help themselves.

Let’s go back to Dr. Gawande’s quote: “Sometimes the best care is the least expensive care.”

We have an opportunity to improve the lives of our patients with disease prevention much further in advance than the lucrative service line strategies of the past.

MACRA was built for it.

Natalie Hodge is a pediatrician and chief medical officer, PreventScripts.

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