Finding Simple Answers
Dr. Atul Gawande on how his life as a surgeon inspired his passion for writing and solving problems
By Leo Brown
My manager once recommended that I read Dr. Atul Gawande’s third book, “The Checklist Manifesto.” She hoped the strategies within would help me remember to do important things. In that job, when I forgot to do important things, problems such as a botched webinar or badly formatted email ensued. In an operating room, the same type of human error can kill.
Gawande’s stories, including three best-selling books and numerous articles published in The New Yorker, offer a glimpse into this hallowed operating room, where split-second decisions make a difference between life and death. On April 21, 2015, as part of the continuing Voices in Leadership series at the Harvard T.H. Chan School of Public Health, Gawande shared his thoughts on leadership, human nature, and how to give patients the care that they deserve.
Gawande claims inauspicious origins as a writer; his grades in college writing courses were mediocre. His explanation? “I think I didn’t have anything to write about.”
This changed during his surgical residency, when Gawande blossomed as a writer through work on an “Internet magazine” in the late 1990s. Not just any aspiring writer has the surgeon’s-eye view; Gawande was learning important lessons on the intensely personal, fallible nature of medicine. Suddenly, he had something to write about! Surrounded by a team of experienced writers and editors, Gawande wrote, rewrote, and revised, soaking in feedback. He was beginning to realize his potential as a writer.
Gawande is well known for his work on reducing medical error. He was initially drawn to the topic because he “was interested in identifying problems that we could solve.” He distinguishes between deaths due to lack of answers or knowledge versus those caused by faulty execution. Faulty execution seemed like a solvable problem.
In “The Checklist Manifesto,” Gawande describes one of his pivotal discoveries and achievements. Drawing on lessons learned from the aviation industry, where checklists are ubiquitous and generally accepted, Gawande shows that simple questions such as “Is this the right patient?” can also save lives in medicine.
This was a controversial proposition, especially among surgeons who valued their independence and personal approach and chafed at the notion of following a templatized protocol.
But Gawande insists that we need more “pit crews” — cooperative teams of caregivers that adhere to established protocols — rather than the stereotypical medical “cowboys” who make unilateral decisions based mainly on their personal professional experience.
Gawande’s book prompted the World Health Organization to ask him to lead the development of a worldwide Safe Surgery Checklist. About his team, Gawande said, “What was clear…was that we all wanted to see whatever we did make a difference.” And they did; Gawande described a striking number of lives saved by his team’s checklist. He added, though, that knowing what works is not sufficient; one also has to get people to do what works. For example, in Scotland, medical teams gathered every few months to answer the question, “What are you doing to roll this out?” It took three years to achieve countrywide adoption, but in that time, they achieved 25% reduction in surgical deaths
In Gawande’s most recent book, “Being Mortal,” he again calls for cultural change in medical care that will make an important difference in the life of a patient. He describes an approach to caring for the elderly that balances compassion and empathy with longevity and clinical outcomes, recognizing that sometimes, the most intensive care is not what the patient wants.
To explain what he meant by this, Gawande spoke with care and concern for an elderly gentleman who kept a stash of unauthorized cookies in his hospital room. What is to be gained from depriving this man of cookies that did not fit his clinically prescribed diet? Better nutrition, perhaps, but at the cost of life’s little pleasures.
Gawande has learned from other caregiving disciplines such as hospice and palliative care to ask questions of his patients such as, “What are your goals?”
He summarizes, “Life is bigger than just aiming for safety.”
Gawande continues his work to solve solvable problems as the Executive Director of Ariadne Labs, an organization that not only develops scalable health care solutions, but also methods of implementation that work. His work at Ariadne is directed toward finding out what works and implementing good programs in fields such as childbirth, surgery, and care for seriously ill patients.
From Gawande’s esteemed place as a writer, a surgeon, and a public health researcher, he is saving and improving lives by finding simple, actionable answers to the hard questions. Gawande sets a powerful example in his tireless work to envision and build a more functional, practical, and sensible system of medical care.
For more from the Voices in Leadership (@VoicesHSPH) series at the Harvard T.H. Chan School of Public Health (@HarvardHSPH), visitwww.hsph.harvard.edu/voices.
Story edited by Jeffrey Reynoso and Nishant Shah
