Saturday, June 11, 2011

Doctors as pit crews?

DB disagrees with some of Atul Gawande's remarks at a recent commencement speech:

Which brings us to the third skill that you must have but haven’t been taught—the ability to implement at scale, the ability to get colleagues along the entire chain of care functioning like pit crews for patients. There is resistance, sometimes vehement resistance, to the efforts that make it possible.

Vehement resistance???? Talk about assuming facts not in evidence. Is Gawande projecting from his early career as a surgeon?


Partly, it is because the work is rooted in different values than the ones we’ve had. They include humility, an understanding that no matter who you are, how experienced or smart, you will fail. They include discipline, the belief that standardization, doing certain things the same way every time, can reduce your failures. And they include teamwork, the recognition that others can save you from failure, no matter who they are in the hierarchy.

Gawande is flat out wrong to imply we've not had these values before. My earliest mentors taught the value of humility. Multidisciplinary was a buzzword early in my career.

Teamwork is important, but as DB points out we must be careful not to devalue individual expertise and judgment.


Tom B said...

It's not doctors as pit crews. It's doctors as pit crew leaders. I mean no disrespect by saying this but humility is not a personality trait I generally equate with physicians. That's not to say I haven't met some extraordinary (and humble) physicians. But arrogant physicians scare me because they don't listen, they scold paramedics and nurses for no good reason and so no one attempts to communicates with them unless it's absolutely necessary. It's one thing to pay lip service to a "multi-disciplinary" team (were non-physicians a part of that team)? It's another to realize that the patient, the patient's family members, paramedics, nurses, and others can help arm the physician (decision maker) with important information. What we're talking about is culture. When the decision maker loses situational awareness patients can be harmed. It's that simple. We get it. You're the doctor.

R. W. Donnell said...

I generally agree with you. I simply think Gawande took the point too far when he implied that the entire professional culture is arrogant and resistant to change. We have a ways to go but I think we've been moving in the right direction for some time.