In our furiously fast-paced world, the practice of medicine isn't as simple as it used to be. In the "good old days" doctors relied on a few basic tools and their own thorough medical knowledge to diagnose and treat patients in hospitals, clinics or even a patient's home.
In his 2011 commencement address to Harvard Medical School and a follow-up essay in the New Yorker, Dr. Atul Gawande likened doctors of times past to cowboys - autonomous, independent and self-sufficient. But that romantic vision of medical practice - and the structure it created simply doesn't work anymore, he said. It results in too many medical errors and other adverse outcomes.
The complexity of medical knowledge today has overwhelmed doctors' ability to maintain the older model of service delivery. For example, treatments now exist for tens of thousands of human medical conditions, and more than 6,000 medications and 4,000 medical and surgical procedures are possible.
With such a huge body of knowledge available, doctors struggle to keep up. As a result, specialists abound. A review of clinical staff-to-patient ratios demonstrates this. In 1970, there were 2.5 care providers to one patient. By 1999, the there were 15 - and those numbers continue to grow.
One result of this drive for specialization, however, is often a lack of attention to primary care.
Fragmented Approach to Care Yields Poor Outcomes at High Cost
According to Gawande, the current piecemeal approach to care is not working. An entirely new structure is needed. The lone cowboy approach is out - and the integrated team approach must replace it. But evidence indicates we have a long way to go. For example:
•· 2 million patients get infections in U.S. hospitals due to provider errors.
•· 40 percent of patients with coronary-artery disease get incomplete or inappropriate care.
•· 60 percent of asthma patients receive incomplete or inappropriate care.
•· Existing knowledge alone could eliminate 50 major surgical complications.
•· Healthcare costs vary dramatically from place to place and do not predict outcomes.
Organized, Integrated Teams and Good Communication Improve Results
In the healthcare system of the future, nothing - and no one - will stand alone. But creating an integrated team of specialists working toward a common goal requires numerous new skills in communication, data collection and analysis and problem-solving - along with the recognition that everyone on the team is vital. Even something as simple as a checklist can be a valuable tool for improving quality and productivity, Gawande believes. It manages complexity by helping define goals and procedures that may fall through the cracks.
Revolution in Healthcare is Now Underway
Two years ago, the Institute for Healthcare Improvement's Open School began offering free online courses in systems skills like outcome measurement, quality improvement, implementation and leadership. A few hundred medical students were expected to enroll. Instead, there were 45,000! Things are changing, indeed.
