Skip to main content

Why we need a new kind of doctor

By Richard Galant, CNN
updated 3:42 PM EDT, Mon May 14, 2012
STORY HIGHLIGHTS
  • Atul Gawande: Medicine developed around the idea of the "cowboy" doctor
  • He says today's doctors don't know it all; they have to specialize and be part of a team
  • He says strong teams in medicine get the best results and provide care more cheaply
  • Gawande: Today's doctor should interact as if he were part of an auto racing pit crew

Editor's note: Atul Gawande spoke at the TED2012 conference in Long Beach, California. TED is a nonprofit organization dedicated to "Ideas worth spreading" which it makes available through talks posted on its website

(CNN) -- In the years before penicillin came into wide use in the 1940s, medicine couldn't do very much for many of the sickest patients. A hospital could keep you warm and provide food and nursing care, but as surgeon and writer Atul Gawande pointed out, in many cases the patient would do no better than if he or she had stayed home.

In those days, doctors who mastered the few techniques that could make a difference, such as setting fractures and treating certain kinds of heart conditions, were seemingly all-powerful, Gawande told the TED2012 conference in March. "A doctor could kind of know it all and do it all," he said in an interview with CNN following his talk.

Doctors were rewarded for being cowboys, for being daring and self sufficient.

Today, the world of medicine promises and provides much more -- cures and care for many of the worst health problems people have.

TED: How do we heal medicine?

But doctors can no longer know everything and do everything. As medical knowledge has exploded, doctors increasingly must specialize in a field to absorb all the relevant information to treat a certain kind of illness. And a patient who goes to a hospital often winds up being treated and cared for by as many as 15 doctors, nurses and therapists, Gawande said.

The result? "Well, it's been a disaster," he said. "We have 40 percent of coronary artery disease patients who receive incomplete or inappropriate care, we have 2 million people pick up infections in hospitals because one of those people on that team failed to follow basic hygiene practices."

Watch Atul Gawande's TED Talk

"Holding on to our streak of autonomy, each of us, we end up losing the patient in between," he said. Gawande, a surgeon at Brigham and Women's Hospital in Boston, also is a researcher at Harvard University and a writer at The New Yorker.

Today doctors are still often rewarded and trained as cowboys, but Gawande says what we really need are doctors who can function as members of a team, the way those in an auto racing pit crew work together to get vehicles back in the race.

Ted.com: Trial, error and the God complex

Gawande has been a pioneer in advocating the use of checklists by medical teams working together in surgery or on other procedures.

"We've had checklists in medicine for people we considered the lowest on the totem pole, but the idea that the surgeon would have to follow a checklist is anathema," Gawande said. But in fact, he added, "when checklists have been used to make sure even the best, most specialized doctors don't miss key steps in providing care ... we're finding that carefully designed checklists cut death rates in half in surgeries, that they can eliminate certain kinds of infections and that they can slash costs."

Gawande has found reason to question the assumption that the most expensive care must be the best care. "What we're discovering is that the best care, the places getting the best results, are often among the least expensive," he said. In those places, doctors and nurses providing care function like teams.

"We are going through a dramatic change where it's no longer about what your doctor knows, it's about what a team of doctors, nurses and others are able to do together."

TED.com: Doctors make mistakes -- can we talk about that?

These days Gawande brings a checklist with him into the operating room. At first, it was a bit of a shock for him.

"I did it reluctantly. I have been someone who believes, you know, do I need a checklist? No ... but i didn't want to be a hypocrite. I was bringing them to Tanzania and Seattle, so I started using a checklist myself. So that meant before the patient went to sleep we would do a series of checks -- not just, 'Do we have the right person and the right side of the body?' But also, 'Do we have a plan for what happens if this is a high-blood-loss case?'

"Before the incision, we'd introduce ourselves by name because it would turn out often that you would have a team of people working together for the first time who may not know each other very well.

"We discuss the plan in detail, and in doing these things I found from the very beginning that we were catching problems that we were missing otherwise. The anesthesiologist or the nurse was noticing things that I had missed.

"I have not gotten through a week of surgery in three years using this kind of checklist without it catching something that was a danger for the patient or would have made the care better."

Follow @CNNOpinion on Twitter and Facebook/CNNOpinion

ADVERTISEMENT
Part of complete coverage on
updated 5:39 PM EST, Mon December 22, 2014
Conservatives know easing the trade embargo with Cuba is good for America. They should just admit it, says Fareed Zakaria.
updated 8:12 PM EST, Fri December 19, 2014
We're a world away from Pakistan in geography, but not in sentiment, writes Donna Brazile.
updated 12:09 PM EST, Fri December 19, 2014
How about a world where we have murderers but no murders? The police still chase down criminals who commit murder, we have trials and justice is handed out...but no one dies.
updated 6:45 PM EST, Thu December 18, 2014
The U.S. must respond to North Korea's alleged hacking of Sony, says Christian Whiton. Failing to do so will only embolden it.
updated 4:34 PM EST, Fri December 19, 2014
President Obama has been flexing his executive muscles lately despite Democrat's losses, writes Gloria Borger
updated 2:51 PM EST, Thu December 18, 2014
Jeff Yang says the film industry's surrender will have lasting implications.
updated 4:13 PM EST, Thu December 18, 2014
Newt Gingrich: No one should underestimate the historic importance of the collapse of American defenses in the Sony Pictures attack.
updated 7:55 AM EST, Wed December 10, 2014
Dean Obeidallah asks how the genuine Stephen Colbert will do, compared to "Stephen Colbert"
updated 12:34 PM EST, Thu December 18, 2014
Some GOP politicians want drug tests for welfare recipients; Eric Liu says bailed-out execs should get equal treatment
updated 8:42 AM EST, Thu December 18, 2014
Louis Perez: Obama introduced a long-absent element of lucidity into U.S. policy on Cuba.
updated 12:40 PM EST, Tue December 16, 2014
The slaughter of more than 130 children by the Pakistani Taliban may prove as pivotal to Pakistan's security policy as the 9/11 attacks were for the U.S., says Peter Bergen.
updated 11:00 AM EST, Wed December 17, 2014
The Internet is an online extension of our own neighborhoods. It's time for us to take their protection just as seriously, says Arun Vishwanath.
updated 4:54 PM EST, Tue December 16, 2014
Gayle Lemmon says we must speak out for the right of children to education -- and peace
updated 5:23 AM EST, Wed December 17, 2014
Russia's economic woes just seem to be getting worse. How will President Vladimir Putin respond? Frida Ghitis gives her take.
updated 1:39 AM EST, Wed December 17, 2014
Australia has generally seen itself as detached from the threat of terrorism. The hostage incident this week may change that, writes Max Barry.
updated 3:20 PM EST, Fri December 12, 2014
Thomas Maier says the trove of letters the Kennedy family has tried to guard from public view gives insight into the Kennedy legacy and the history of era.
updated 9:56 AM EST, Mon December 15, 2014
Will Congress reform the CIA? It's probably best not to expect much from Washington. This is not the 1970s, and the chances for substantive reform are not good.
updated 4:01 PM EST, Mon December 15, 2014
From superstorms to droughts, not a week goes by without a major disruption somewhere in the U.S. But with the right planning, natural disasters don't have to be devastating.
updated 9:53 AM EST, Mon December 15, 2014
Would you rather be sexy or smart? Carol Costello says she hates this dumb question.
updated 5:53 PM EST, Sun December 14, 2014
A story about Pope Francis allegedly saying animals can go to heaven went viral late last week. The problem is that it wasn't true. Heidi Schlumpf looks at the discussion.
updated 10:50 AM EST, Sun December 14, 2014
Democratic leaders should wake up to the reality that the party's path to electoral power runs through the streets, where part of the party's base has been marching for months, says Errol Louis
updated 4:23 PM EST, Sat December 13, 2014
David Gergen: John Brennan deserves a national salute for his efforts to put the report about the CIA in perspective
updated 9:26 AM EST, Fri December 12, 2014
Anwar Sanders says that in some ways, cops and protesters are on the same side
updated 9:39 AM EST, Thu December 11, 2014
A view by Samir Naji, a Yemeni who was accused of serving in Osama bin Laden's security detail and imprisoned for nearly 13 years without charge in Guantanamo Bay
updated 12:38 PM EST, Sun December 14, 2014
S.E. Cupp asks: How much reality do you really want in your escapist TV fare?
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT