Atul Gawande: Future of healthcare requires constant reinvention
Atul Gawande, MD, professor of surgery at Harvard Medical School and staff writer at The New Yorker, offered a reflective presentation earlier this month at Health Datapalooza IV, taking the audience back through what the healthcare system used to look like, and showing and how data innovations have helped set the stage for big transformations.
"There was a period in time where there was no analytics, no effort to look at the data, no effort to understand what was happening," Gawande said. In his mind, healthcare is at least heading in the right direction.
Despite these innovations, all this progress and the potential power of big data, however, Gawande made sure to differentiate between technology and medicine – arguing that it was crucial to remember the human element.
[See also: Slideshow: Health Datapalooza IV.]
Gawande referenced Lewis Thomas, MD, who got through medical school by selling poetry and blood. Lewis went on to head Memorial Sloan-Kettering and eventually won a National Book Award for his essays.
Gawande cited one of Thomas’s essays in particular that would become the topic of his presentation, one titled, “Technology of Medicine.”
“What I love about it, is it looked at how we pay for technology in healthcare, what it goes for, but did it at a time where people really weren't thinking about this,” Gawande said. “The opening you will love because it’s incredibly quaint. He says, ‘Somehow medicine, for all the $80-odd billion that it is said to cost the nation has not yet come in for much analytical treatment.’”
He added that Thomas "knew it was coming. He knew people would be here.” Gawande continued, “And then addressing himself to you, he said, 'I wish you well, but I imagine you are having a bewildering time.' The answer is, 'Yes.'”
Gawande cited Thomas’s idea of three technologies. The first, non-technology, represents the supportive care that's deployed in our current system – care for ailments like cirrhosis or multiple sclerosis.
[See also: 'Data drunks' and 'dataholics' unite.]
The second technology is complete technology. The polio vaccine is emblematic, Gawande said. Complete technology is a full solution for a particular disease.
The third technology – incomplete technology – is where innovation most needs to occur. These technologies are designed to manage the process of disease but not prevent it or reverse. He cited heart transplantations, chemotherapy and complex treatment for cardiac disease as examples. These technologies, Gawande explained, are both “highly sophisticated and highly primitive.”
There exist only a few examples of complete technologies. “The rest has not found its complete technology,” he added. “It's squeezing out the rest of life and society. We're experiencing growth again in our economy, but what often goes unmentioned is that although the healthcare costs have slowed down, if you look over the last decade, virtually all of the economic growth that has occurred has been shunted to paying for healthcare goods and services, with virtually no increases in investment in our infrastructure, in education and other core elements of what our future of this country will require.”
Gawande explained that the healthcare business has gone from the most primitive level of, ‘You ought to do X’ to the medieval period of standards and guidelines being developed, which transformed into, ‘You really ought to do X, and here are the guidelines on how to do it.’
He recalled when the Harvard standards came out, they finally outlined that anesthesiologists could not leave the room when with a patient, a common occurrence in the day.
“My dad was a surgeon in rural Ohio," said Gawande. "He used to complain and come home shouting almost that the damn anesthesiologist left to go smoke a cigarette. When those Harvard guidelines got published, he came in waiving them at the anesthesiologist.”
Then came checklists and feedback loops both of which improved healthcare safety enormously. A pulse oximeter on the finger gave people the feedback loops to see, “Hey, you might have turned the oxygen down to zero. They're not breathing.”
The next stage was the forcing function: Machines got made that prevented one from turning the oxygen to zero.
Modern quality, he continued, is a “combination of processed innovations like simple checklists and feedback loops, ways of knowing if you are making your way more successfully than you were before.” But, he said, that “still is not the future of what we can do.”
The future is innovation, Gawande said. It's “the automation of the best possible ways of doing things while constantly reinventing them.”