Here’s a bit of a personal question for all of you veterans of many RSNAs: have you ever teared up during a talk? I assure you, my eyes usually remain as dry as McCormick Center air. But I welled up during this afternoon’s special lecture by Atul Gawande, MD, MPH, associate professor of medicine at Harvard and staff writer for The New Yorker. Gawande was speaking on the topic of “Real Reform: Facing the Complexity of Health Care,” and I found his presentation to be, in a word, inspirational.
Funnily enough, just before I headed down to the Arie Crown theater for Dr. Gawande’s talk, I shared a lunch table with two of my fellow RSNAers. We were all strangers, but we enjoyed a lively twenty-minute conversation about the vagaries of health care both here and around the world (one of us was Swedish). Our discussion was still very much on my mind when Gawande said, “Every country is now struggling desperately with health care and how to afford it . . . there’s no question that government rules or the financing of different kinds of companies can make our jobs harder, but at the root of our problems is complexity.”
He went on to talk about how there are really only two kinds of human failure: failures that result from ignorance and failures that result from ineptitude. “For millennia, we lived in a world of ignorance, but in the last century, our knowledge has advanced enormously,” he said, showing off the prose-ing skills that separate New Yorker writers from the rest of us. “We cannot always cure, but we can do a lot; but in order to do so, we have an arsenal of over 6,000 drugs and over 4,000 procedures, and we’re attempting to deploy those capabilities town by town to every person alive. I call it the greatest human endeavor that has ever been attempted, and it’s turning out to be hard. We now need a science to understand how to deal with our knowledge.”
Gawande’s central thesis – which you may be able to guess if you’ve read any of his bestselling books, or if, like me, you memorized his 2008 article “The Cost Conundrum” – is that health care is not inherently expensive; instead, it’s the fact that it’s often deployed ineptly that drives up costs, making it unsustainable to provide care for everyone at every income level. If, he argued, physicians were to get together and collaborate on a new care model that would revolutionize delivery the way, say, checklists can revolutionize surgical outcomes in hospitals, we’d find the percentage of our GDP that health care occupies shrinking even as our quality drastically improved. “My premise,” he said, “is that systems innovation will save more lives in the next decade than all of our efforts at bench science discovery will. At the soul of this is a battle for the soul of medicine.”
He concluded by mentioning his father, a surgeon who retired last year after an astrocytoma was found in his brain stem. Here’s the part where I felt my eyes filling, so you might want to have your tissues handy. “He has received extraordinary care in Ohio, where I’m from – surgery, radiation,” Gawande said. “I believe that great care is possible for him. And I also believe that great care for him does not need to bankrupt the future of my children.”