Atul Gawande and His Pesky Checklists

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The New Yorker’s Atul Gawande wrote one of the most influential stories about health care in 2009. The piece, published in June, was about geographic disparities in health spending, specifically why McAllen, Texas is one of the most expensive places in the country to get medical care. The article raised so many vital questions about the dysfunction of the U.S. health care system that Barack Obama was said to be carrying the article around the White House, urging staffers and lawmakers to read it. The President even mentioned the story in a speech to the American Medical Association.

Gawande, in addition to being a New Yorker writer, Harvard-educated surgeon and former adviser to Bill Clinton, is also the author of the books Complications: A Surgeon’s Notes On An Imperfect Science and Better: A Surgeon’s Notes On Performance. Well, Gawande has a new book out called The Checklist Manifesto, which was the reason he appeared on the Daily Show last night. (Clip after the jump.)

I’m drawing attention to Gawande not because he’s a terrific writer, which he is, or because he’s an impressively thorough reporter, which he is, or because he wrote one of the most important health care stories of 2009, which he did. I’m not even drawing attention to him because it just doesn’t seem fair that someone is allowed to be all those things in addition to being an endocrine surgeon and a Harvard professor and a global public health guru. I’m drawing attention to Gawande because many of the topics he writes about are at the heart of what’s wrong with the U.S. health care system.

Yes, there are bad government policies and unfair insurance practices. But what Gawande writes about are things like doctors who have a financial stake in providing too much care, which leads to wasteful spending. He writes about avoidable hospital-acquired infections that lead to unnecessary deaths and untold unnecessary spending. In his new book, Gawande writes about how if doctors follow simple checklists, they can avoid all kinds of complications, pain and confusion. Oh yeah, they could also save many more lives. Items on these checklists include things like confirming a patient’s identity before performing surgery and making sure an operating room is sterile. Simple stuff, but overlooked far too often.

On the Daily Show, Gawande touched on one of the biggest obstacles to implementing a checklist system in hospitals – the doctors who resent an added layer of bureaucracy and any implication that they are not careful, meticulous practitioners of medicine. But the argument Gawande makes is that doctors, nurses, and administrators need to start getting real about some of the fixable problems on the front lines of health care. Spending and regulation are critical parts of the health care system. But so are hand washing stations in the ICU. In other words, there’s a lot that could be done to make the U.S. health care system better and more efficient that has nothing to do with Congress.

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