intro’d to Atul via Liz recommending .. being mortal
his ted2012 – how do we heal medicine
6 min – in 1970..took just over two full-time equivs of clinicians..nursing time and little bit for a dr..more/less checked in once/day..by end of the 20th cent..more than 15 clinicians for same typical hospital patient..specialists..physical therapists..nurses
7 min – our experience as people who get sick..need help..is that we have amazing clinicians ..incredible techs..but little sense that it consistently all comes together for you from start to finish in a successful way
9 min – we found that the most expensive care is not necessarily the best care.. and best care turns out to be least.. and what that means is.. there’s hope.. don’t have to ration medicare…
10 min – when we look at best results… *the ones that look the most like systems are the most successful.. found ways to get all components/pieces to come together as a whole…they found ways to get all of diff pieces/components to come together into a whole..
having great components is not enough..and yet we’ve been obsessed in medicine with components…terrible design strategy
skill one..find where failures are
skill two..devise solutions
there’s a deep resistance (to implementation) because using these tools forces us to confront that we’re not a system..to behave with a diff set of values
ted 2017 – want to get great at something get a coach
Just watch it. @Atul_Gawande is so amazing: https://t.co/uf9FDsGdTS
Original Tweet: https://twitter.com/HelenWalters/status/941749805776363521
how people improve in the face of complexity.. or don’t..
birth.. 22 drugs on site
how do professionals get better at what they do:
1\ traditional pedagogical.. go to school..prof capable of managing own improvement.. the thing is it works.. tutors..inculcating ways of thinking and learning to can do it on own when done
2\ sports.. say you are never done.. everyone needs a coach.. so to me.. pay someone to come into my room and have them observe me.. seems absurd..
asked perlman.. why don’t violinists have coaches.. and he said.. i don’t know.. but i always had a coach.. his wife.. to listen and give feedback
turns out there are numerous problems on making it on your own.. somewhere along the way.. you stop improving..
coaches – external eyes and ears
coaches were onto something profoundly important..
MacArthur Foundation (@macfound) tweeted at 7:01 AM – 23 Dec 2017 :
#MacFellow @Atul_Gawande on how clinicians can better collaborate using systems: https://t.co/eqmy64ItAy via @NPR (http://twitter.com/macfound/status/944568526160793600?s=17)
links to his ted on coaches
Surgeon, Writer, Researcher, Dilettante.
Atul Gawande (born November 5, 1965) is an American surgeon, writer, and public health researcher. He practices general and endocrine surgery at Brigham and Women’s Hospital in Boston, Massachusetts. He is a professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Healthand the Samuel O. Thier Professor of Surgery at Harvard Medical School. In public health, he is executive director of Ariadne Labs, a joint center for health systems innovation, and chairman of Lifebox, a nonprofit that works on reducing deaths in surgery globally.
He has written extensively on medicine and public health for The New Yorker and Slate, and is the author of the books Complications, Better, The Checklist Manifesto, and Being Mortal.
My commencement address at UCLA Med School yesterday in @newyorker, in which I tell the story of treating a prisoner and sorting out what we mean when we say we are all created equal. https://t.co/VrgOIX4YWw
Original Tweet: https://twitter.com/Atul_Gawande/status/1002953956585177088
We are in a dangerous moment because every kind of curiosity is under attack—scientific curiosity, journalistic curiosity, artistic curiosity, cultural curiosity. This is what happens when the abiding emotions have become anger and fear.
Among the most important capacities that you take with you today is your curiosity.
When others say that someone is evil or crazy, or even a hero or an angel, they are usually trying to shut off curiosity.
When people speak, they aren’t just expressing their ideas; they are, even more, expressing their emotions. And it’s the emotions that they really want heard. So I stopped listening to the man’s words and tried to listen for the emotions.
I didn’t understand him or like him. But all it took to see his humanity—to be able to treat him—was to supply that tiny bit of openness and curiosity.
Atul Gawande (@Atul_Gawande) tweeted at 5:09 AM – 18 Jun 2019 :
There are >10,000 mental health apps. Can any of them actually work at scale to improve outcomes? Thank you California for investing in an effort to find out. https://t.co/pBDPiXZIux (http://twitter.com/Atul_Gawande/status/1140939640414883841?s=17)
Between Mindstrong and 7 Cups, Californians in the state’s public medical system could, in theory, have both an early warning system and quick access to appropriate services..t
better to get to the roots of healing.. than getting more efficient at ‘putting out fires’
App developers may yet transform mental health care. But the story so far suggests that they won’t be able to program their way out of the hard, incremental work of testing new treatments.
again.. roots of healing over more efficient (whatever) healings/treatments
“The thing about California, it has a huge number of people in the public system,” Dr. Insel said. “At least it’s willing to ask: ‘Why isn’t this working? Why aren’t counties working with this amazing tech sector?’ And then do something about it.”..t
Such a sane, helpful piece. Can we please give @AtulGawande an award or something? Thank you Doctor! Amid the Coronavirus Crisis, a Regimen for Reëntry https://t.co/Bs2ejuipu2 via @NewYorker
Original Tweet: https://twitter.com/CathyNDavidson/status/1260628664464662528
frequency (of washing) makes a bigger difference than many realize
physical distancing is so important – but more like 20 ft
testing is important
mask as source control
The four pillars of our strategy—hygiene, distancing, screening, and masks—will not return us to normal life, but, when signs indicate that the virus is under control, they could get people out of their homes and moving again. As I think about how my workplace’s regimen could be transferred to life outside the hospital, however, I have come to realize that there is a fifth element to success: culture. It’s one thing to know what we should be doing; it’s another to do it, rigorously and thoroughly.
It’s about wanting, among other things, never to be the one to make someone else sick.
At Lasell Village, Doyle is doing what she can to create cultural change under pressure. She has made sure that all her staff has enough paid sick time.
Still, regardless of what model politicians set, more and more people are figuring out how to do what has worked in health care, embracing new norms just as we accepted social distancing. We see proof of a changing culture every time we step out and find a neighbor in a mask. Or when we spend time to make our own fit better. Or when we’re asked whether we have any concerning symptoms today. Or when we check to see whether the number of covid-19 cases in our community has dropped low enough to warrant reëntry. If we stick to our combination of precautions—while remaining alert to their limitations—it will.