Tag Archives: atul-gawande

Medicine, Specialism, and the Scientific Education

In the commencement speech he delivered to the graduates of Stanford’s School of Medicine earlier this year, Atul Gawande eloquently (as ever) examined the state of modern medicine (in the U.S. specifically, the world generally), the problem with specialism, and the problem of specialists trying to fit into a system not necessarily designed for it.

I particularly like Gawande’s analogy on the experience of a scientific education:

The experience of a medical and scientific education is transformational. It is like moving to a new country. At first, you don’t know the language, let alone the customs and concepts. But then, almost imperceptibly, that changes. Half the words you now routinely use you did not know existed when you started: words like arterial-blood gas, nasogastric tube, microarray, logistic regression, NMDA receptor, velluvial matrix.

O.K., I made that last one up. But the velluvial matrix sounds like something you should know about, doesn’t it? And that’s the problem. I will let you in on a little secret. You never stop wondering if there is a velluvial matrix you should know about.

via Intelligent Life

The Checklist Advantage

To ensure that extremely complex tasks–tasks too complex even for “super-specialists”–are performed effectively, accurately and with minimal mistakes, checklists are an invaluable tool, suggested Atul Gawande in a 2007 article in The New Yorker (and everywhere else since, it seems).

Gawande illustrates (in an inordinate amount of detail) how seemingly unnecessary checklists can make huge differences to our effectiveness in completing the most complex (and simple) of tasks by looking at how Peter Pronovost dramatically reduced infection rates (from 11% to 0% in some cases*) in hospitals throughout America.

So how do you actually manage [immense] complexity? The solution that the medical profession has favored is specialization. […]

We now live in the era of the super-specialist—of clinicians who have taken the time to practice at one narrow thing until they can do it better than anyone who hasn’t. Super-specialists have two advantages over ordinary specialists: greater knowledge of the details that matter and an ability to handle the complexities of the job. [But] what do you do when expertise is not enough? […]

It’s far from obvious that something as simple as a checklist could be of much help in medical care. […] Mapping out the proper steps for each [patient] is not possible, and physicians have been skeptical that a piece of paper with a bunch of little boxes would improve matters much.

In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. […]

The checklists provided two main benefits, Pronovost observed. First, they helped with memory recall, especially with mundane matters that are easily overlooked in patients undergoing more drastic events. […] A second effect was to make explicit the minimum, expected steps in complex processes.

Gawande notes how Pronovost enabled the widespread use of checklists by persuading hospital management to actively encourage and take the side of those lower down in the professional hierarchy (i.e. nurses) to challenge those above them (i.e. consultants) without recriminations.

via @zambonini

*The checklist used was extremely simple and contained only five steps. It was so simple that it was resisted by almost every employee. With the checklist actually being consulted readily, it turned out that at least one step was either missed or not implemented correctly in many cases.

Neurology of the Itch

The Itch is an article from The New Yorker on the neurology behind that annoying sensation we’ve all had.

I warn you, the article is quite icky in places, with a particularly stomach churning case study in one place, but I was quite fascinated to find out that the sensation of the itch seems to rely on itch dedicated nerve cells, distinct from the nerves that transmit pain.

One of the most interesting things is that itch seems to be one of the sensations most sensitive to psychological state. For example, I guarantee you’ll feel more itchy just reading the article (and probably already reading this).

via Mind Hacks

Edit: Kottke has written a good review of the article that is worth your time.