Every time you read essays written by Atul Gawande you are on a high, high achieved through his honest and extremely sorted thought process. He brings his perspective as a physician/surgeon but he correlates his learning and understanding quite easily to other professions and disciplines. His latest essay had the same impact, same heady impact. This is not the first time, I have longed to read his books. Below is an excerpt from his aforementioned article:
We care about results in sports, and if we care half as much about results in schools and in hospitals we may reach the same conclusion. Local health systems may need to go the way of the Albemarle school district. We could create coaching programs not only for surgeons but for other doctors, too—internists aiming to sharpen their diagnostic skills, cardiologists aiming to improve their heart-attack outcomes, and all of us who have to figure out ways to use our resources more efficiently. In the past year, I’ve thought nothing of asking my hospital to spend some hundred thousand dollars to upgrade the surgical equipment I use, in the vague hope of giving me finer precision and reducing complications. Avoiding just one major complication saves, on average, fourteen thousand dollars in medical costs—not to mention harm to a human being. So it seems worth it. But the three or four hours I’ve spent with Osteen each month have almost certainly added more to my capabilities than any of this.Talk about medical progress, and people think about technology. We await every new cancer drug as if it will be our salvation. We dream of personalized genomics, vaccines against heart disease, and the unfathomed efficiencies from information technology. I would never deny the potential value of such breakthroughs. My teen-age son was spared high-risk aortic surgery a couple of years ago by a brief stent procedure that didn’t exist when he was born. But the capabilities of doctors matter every bit as much as the technology. This is true of all professions. What ultimately makes the difference is how well people use technology. We have devoted disastrously little attention to fostering those abilities.
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Annals of Medicine, The New Yorker Oct 2011
Personal Best, Atul Gawande
Coaching a surgeon: What makes top performers better?
Atul Gawande’s advocacy for surgical coaching to improve procedural and cognitive performance in the operating room is a fine example to all physicians and surgeons. It takes humility and self-scrutinizing insight to recognize that finely honed clinical judgment and skills acquired over long years of training degrade over time. To openly admit to being able to do things better, correct ingrained habits and maintain high treatment standards should be a high tide mark for any medical doctor. Adopting personal initiatives to optimize patient care (rather than being compelled by directives from above) demands respect from colleagues and admiration from patients.
Some uncertainties remain however. Coaching could have a different type of impact in non-procedural specialties where cognitive demands are at a higher premium. It would be difficult to isolate the benefit of coaching from the improved performance resulting from being put under the discerning microscope of an esteemed peer. If merely being scrutinized is the crucial factor, then performance enhancement demands career-long supervision rather than periodic coaching. The coaching that a competent clinician volunteers for could be misinterpreted by colleagues as being remedial for technical weakness or impaired clinical judgment. Like compliance with continuing medical education and assessment for clinical competency, if coaching is convincingly shown to improve patient outcomes, it has to be made mandatory for all clinicians. Stiff resistance and a long hard battle is in the wind in that case.
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