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 9:56 AM EDT, Tue July 22, 2014
Ukraine's president says the downing of MH17 was a terrorist act, but Richard Barrett says it would be considered terrorism only if it was intentional
updated 4:15 PM EDT, Tue July 22, 2014
Robert McIntyre says the loophole that lets firms avoid taxes should be closed
updated 8:50 AM EDT, Wed July 23, 2014
Aaron Miller says Kerry needs the cooperation of Hamas, Israel, Egypt and others if he is to succeed in his peacemaking efforts
updated 11:35 AM EDT, Tue July 22, 2014
Jeronimo Saldana and Malik Burnett say Gov. Perry's plan to send National Guard to the border won't solve the escalating immigration problem.
updated 1:42 PM EDT, Tue July 22, 2014
Sally Kohn: The world's fish and waters are polluted and under threat. Be very careful what fish you eat
updated 8:42 AM EDT, Tue July 22, 2014
Les Abend says threat information that pilots respond to is only as good as the intelligence from air traffic controllers. And none of it is a match for a radar-guided missile
updated 8:35 AM EDT, Mon July 21, 2014
Frida Ghitis: Anger over MH17 is growing against pro-Russia separatists. It's time for the Dutch government to lead, she writes
updated 8:27 AM EDT, Mon July 21, 2014
Julian Zelizer says President Obama called inequality the "defining challenge" of our time but hasn't followed through.
updated 7:57 AM EDT, Mon July 21, 2014
Gene Seymour says the 'Rockford Files' actor worked the persona of the principled coward, charming audiences on big and small screen for generations
updated 10:17 AM EDT, Mon July 21, 2014
Daniel Treisman says that when the Russian leader tied his fate to the Ukraine separatists, he set the stage for his current risky predicament
updated 12:42 PM EDT, Fri July 18, 2014
Andrew Kuchins says urgent diplomacy -- not sanctions -- is needed to de-escalate the conflict in Ukraine that helped lead to the downing of an airliner there.
updated 9:50 PM EDT, Fri July 18, 2014
Jim Hall and Peter Goelz say there should be an immediate and thorough investigation into what happened to MH17.
updated 11:07 AM EDT, Fri July 18, 2014
Pilot Bill Palmer says main defense commercial jets have against missiles is to avoid flying over conflict areas.
updated 1:55 PM EDT, Sun July 20, 2014
Valerie Jarrett says that working women should not be discriminated against because they are pregnant.
updated 3:53 PM EDT, Mon July 21, 2014
David Wheeler says the next time you get a difficult customer representative, think about recording the call.
updated 3:33 PM EDT, Fri July 18, 2014
Newt Gingrich says the more dangerous the world becomes the more Obama hides in a fantasy world.
updated 6:11 AM EDT, Fri July 18, 2014
Michael Desch: It's hard to see why anyone, including Russia and its local allies, would have intentionally targeted the Malaysian Airlines flight
updated 3:14 PM EDT, Thu July 17, 2014
LZ Granderson says we must remember our visceral horror at the news of children killed in an airstrike on a Gaza beach next time our politicians talk of war
updated 8:06 AM EDT, Thu July 17, 2014
Sally Kohn says now the House GOP wants to sue Obama for not implementing a law fast enough, a law they voted down 50 times, all reason has left the room.
updated 8:14 AM EDT, Thu July 17, 2014
A street sign for Wall Street
Sens. Elizabeth Warren, John McCain and others want to scale back the "too big to fail" banks that put us at risk of another financial collapse.
updated 4:16 PM EDT, Thu July 17, 2014
Newt Gingrich writes an open letter to Robert McDonald, the nominee to head the Veterans Administration.
updated 12:01 PM EDT, Fri July 18, 2014
Paul Begala says Dick Cheney has caused an inordinate amount of damage yet continues in a relentless effort to revise the history of his failures.
updated 10:04 AM EDT, Fri July 18, 2014
Kids who takes cell phones to bed are not sleeping, says Mel Robbins. Make them park their phones with the parents at night.
updated 1:29 PM EDT, Thu July 17, 2014
Buzz Aldrin looked at planet Earth as he stood on talcum-like lunar dust 45 years ago. He thinks the next frontier should be Mars.
updated 2:04 PM EDT, Wed July 16, 2014
Mark Zeller never thought my Afghan translator would save his life by killing two Taliban fighters who were about to kill him. The Taliban retaliated by placing him on the top of its kill list.
updated 11:18 AM EDT, Thu July 17, 2014
Jeff Yang says an all-white cast of Asian characters in cartoonish costumes is racially offensive.
updated 9:24 PM EDT, Wed July 16, 2014
Gary Ginsberg says the late John F. Kennedy Jr.'s reaction to an event in 1995 summed up his character
updated 12:41 PM EDT, Wed July 16, 2014
Meg Urry says most falling space debris lands on the planet harmlessly and with no witnesses.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT