the Future of Medicine is…

healthcare reformMy Comments: I claim no authority on this topic. However, because I often work with physicians, I’m very aware of the pressures that apply to the profession. There are many issues on which no individual has any control, one of them the apparent erosion of the profession in terms of college graduates not seeking admittance to medical school.

Demographics alone tells you there is likely to be a need for MORE physicians in the coming years, not less. How do we as a society create the conditions that will cause this demand to be met? Is there a way? What has to happen?

While this comes at the problem from the negative, there are lessons here, even though the message comes from Great Britain.

November 19, 2014 / By Clive Cookson / The Financial Times

The Reith Lectures 2014 on The Future of Medicine, Atul Gawande, BBC Radio 4, from November 25

We all know how personal anecdote can illuminate talks about grand themes such as the future of medicine. But few speakers carry off the art of storytelling as well as the surgeon and writer Atul Gawande in this year’s Reith Lectures on BBC Radio 4.

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The first of four, “Why Do Doctors Fail”, to be broadcast on Tuesday, was recorded in Gawande’s home city of Boston, where he is a medical professor at Harvard University. It begins with a poignant account of his son Walker severely ill in a local hospital almost 20 years ago. The 11-day-old boy almost died because an oxygen probe was attached to a finger on his right hand when it should have been on the left hand.

The blood oxygen reading suggested to the emergency room staff that Walker’s problem lay in his lungs, when in fact the failure was cardiovascular – his aorta had not developed properly. An alert paediatrician detected the error just in time to open up Walker’s circulation but not in time for a baby in the next bed with the same diagnosis, who suffered multiple organ failure.

Gawande weaves the details of Walker’s illness and recovery into his exploration of the nature of fallibility in modern healthcare. As he says, doctors have acquired an enormous arsenal to fight disease and promote good health but far too often avoidable mistakes stop it being used to best effect.

“The story [of medicine] has become as much about struggling with ineptitude as with ignorance,” he says.

The second lecture, “The Century of the System”, was recorded in London and starts with an even longer story. Gawande devotes the first nine minutes of his 25-minute talk to a three-year-old Austrian girl. She “drowned” in an icy pond and was brought back first to life and then to health through a complex sequence of procedures, which Gawande describes in gripping detail.

The point is that great complexity is inevitable if patients are to benefit fully from modern medicine. But it only works – as with the Austrian system, which was developed originally to treat avalanche victims – if everyone knows his or her role and follows procedures.

“We have been fooled by penicillin” into imagining that medicine is about simple cures, Gawande says, while in reality it is about complex solutions to complex problems. This requires effective systems, implemented with the help of checklists of the sort that are routine in other safety-critical industries such as aviation but only now being implemented in healthcare.

Checklists have cut complication and mortality rates in hospitals around the world, as Gawande points out. A minority of surgeons dislike checklists on the grounds that they interfere with individual brilliance and daring, an objection that he dismisses with the memorable statement: “Discipline makes daring possible.”

Sue Lawley, who has presented and chaired the Reith Lectures since 2002, rightly calls them “the epitome of public service broadcasting”. They were inaugurated in 1948 to honour John Reith, the BBC’s first director-general, who believed fervently in the corporation’s duty to enrich the intellectual life of the nation. Gawande follows several figures from science and medicine who have given memorable Reith Lectures. Although listeners who have read his books such as The Checklist Manifesto will recognise recycled material, his warm and clear delivery gives it fresh appeal. And everyone will love his stories.