Atul Gawande on the Secrets of a Puzzle-Filled Career

; Atul Gawande, MD, MPH


December 06, 2013

In This Article

Three Legs of the Stool

Dr. Topol: So, what's next? You've obviously got another book. You've got this new innovation center; maybe you want to talk a little bit about that?

Dr. Gawande: The 3 legs of the stool had been practicing surgery, writing (which has been very connected to the vantage that I have from practicing surgery), and I had a research crew that got much less attention but was still a very satisfying part of what I do and revolves around discoveries that can make surgical care better. It gradually coalesced into my last book, The Checklist Manifesto, where we identified that a simple checklist pulling together the most effective interventions in surgery and teamwork -- team communication -- could cut deaths in surgery by 45%. It's been replicated in multiple places, and we're now doing experiments on how to spread it to various populations of the world.

As we did that, we found that there is a pattern to how to make discoveries and make health systems better. We then launched a project in childbirth that is now scaling in North India. And we started a group in 2011 around improving end-of-life care for people who are terminally ill; it's now a randomized trial involving every team at the Dana-Farber Cancer Institute. The results have been really terrific and we're about to scale that up. We had to build an organization [called Lifebox][5] to keep it afloat because my research crew comprises about 35 people, and everything is going relatively quickly; we're doing about 12 projects in 80 health systems in 7 countries in these 3 areas right now.

Throwing a Rock in the Pond

Dr. Topol: Did you ever think your checklist and these ways to improve the delivery of care could take off to this degree and this fast?

Dr. Gawande: No, not at all. It's been the same process that unfolds in the writing: Tackle a problem that's interesting, one that feels like a big problem, and then use the tools you have. Sometimes it's storytelling to unfold it, sometimes it's data collection, and sometimes it's an intervention to kind of nudge the system, disturb it a little bit and see whether it makes things better or not. You've been in the disturbance business a little bit.

Dr. Topol: Tried that out a couple of times.

Dr. Gawande: You throw a rock in the pond and you see what ripples come. As long as you're measuring and looking to see whether you're improving matters and then learning from that, you just hope that it then helps [someone].

Dr. Topol: I can't imagine you ever getting bored.

Dr. Gawande: Right. Boredom is not the problem. I've weeded out all of the stuff that feels like un-useful time.

The danger is just burning out, but I keep finding interesting things to do. I don't know where the twists will come exactly. Here you are -- you've become an online media editor and thinker. You would not have predicted when you started your cardiology career that this would be a fundamental part of what you do.

Dr. Topol: Right.

Dr. Gawande: And to me this is a fascinating period in medicine. We're all trying to figure out how to make systems work instead of just using drugs and devices. It's opened up huge possibilities for young physicians, for people late in their career. Because this enormous shift is happening, and everybody, virtually everybody, agrees that we can't just keep doing it the way we've been doing it. Boredom is not the problem.

Dr. Topol: I think what you exemplify is how you can take medicine and make it so pluripotent, and doing it at a time when some physicians are getting disenchanted because of all of the pressures that are out there. You've been able to show, in an iconic way, all of the diversity that exists and how rich medicine can be. You've had a phenomenal career and you're so young. There are a lot more chapters to come.

Thank you so much for joining us, Atul, on Medscape One-on-One. We've been trying to bring the most interesting people in the medical world to Medscape, and I think we have one right here.


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