Atul Gawande - Better and The Checklist Manifesto

After hearing Dr. Gawande speak at the Jan. 26th 2012 Care Innovations Summit, I was interested in reading his books.  Since then, I read "The Checklist Manifesto" and just finished "better - A Surgeon's Notes on Performance."  Dr. Gawande delivers the healthcare story so entertaingly and with so many stories and much historical perspective and insight, I will never do him justice, but I would encourage you to pick up some of his books as well.  I believe he is one of the most thoughtful, visionary, brilliant, humorous, and humble storyteller writers in the healthcare space, and I know you would enjoy his writing.

Just to recap the contents of "better" - Dr. Gawande presents "Diligence" in Part I, with chapters on Washing Hands to prevent horrendous hospital-acquired infections, The Mop Up for vaccinating children in India against Polio to ERADICATE the disease, and Casualties of War, where he reviews the military's continuous improvement process that has saved so many lives that before would never have been saved.

In Part II, "Doing Right" is about doctors going "Naked" with data to expose where their care center is compared to others with outcomes; he points to the Cystic Fibrosis example, where Fairview Children's in MN achieved the best outcomes through a combination of excellent, dedicated, personable, persevering physicians and leading-edge techniques. The subject of Malpractice is addressed in "What Doctors Owe," pointing to the very difficult issue that physicians aren't perfect (just like baseball players - but a 5% error rate in baseball doesn't impact lives) but the malpractice system doesn't fix what's wrong with the system.  He discusses physician compensation in "Piecework," with an analysis of how reimbursement methodologies came to be, and doctor's roles in capital punishment in "The Doctors of the Death Chamber."  The final chapter in Part II is called "On Fighting," where Dr. Gawande asserts that the best doctors are those that will always fight but also recognize when the fight is not about the patient, but about their own egos.

Part III, "Ingenuity," addresses "The Score," or how to rate physician performance in areas such as obgyn, where midwives have been found to demonstrate better outcomes.  "The Bell Curve" and "For Performance" present the fact that performance is always on a bell curve, and what does that mean for medicine; while also taking us to poor India to understand that performance really should be looked at through the reality of what doctors are able to do without any of the western world resources, technologies and supplies; doctors there delivery miracles daily.

Dr. Gawande ends with 5 suggestions for becoming a Positive Deviant in this world that are good for us all:

1. Ask an unscripted question.  (helps you learn about and appreciate the people around you.)
2. Don't complain.  Nothing is more of a downer than doctors (and other people) complaining.
3. Count something.  Makes you learn something about something you are interested in.  His example: surgical sponges.
4. Write something.  Add some small observation about your world.  (That's what I'm doing here.)
5. Change.  Make yourself an early adopter.

Have a great day - and pick up one of Dr. Gawande's publications!