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Atul Gawande

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Med schools to teach students how to talk to patients about end-of-life aims

May 9, 2017by Robert Whitcomb in Uncategorized tagged ,

bedside

The Boston Globe reports on how the four medical schools in Massachusetts have jointly agreed “to teach students and residents how to talk with patients about what they want from life, so future doctors will know how far to go in keeping gravely ill patients alive.”

“’We’ve trained all doctors to ask people, ‘Do you smoke?’” said Dr. Harris A. Berman, dean of the Tufts University School of Medicine, who met with colleagues last week from the medical schools at Tufts, Harvard, Boston University, and the University of Massachusetts. ‘We’ve trained people to ask about sexual preference. That used to be a difficult discussion to have.”’

Now,  Dr. Berman told The Globe,  physicians should learn how to ask even more deeply personal questions, such as: “What most matters to you? What do you need to make life worth living? In what circumstances would you rather not be alive?”

The newspaper reported that the medical schools’ project  stems from the work of the Massachusetts Coalition for Serious Illness Care, “a year-old consortium working to ensure that every resident receives the medical care they want — no more, no less. Dr. Atul Gawande, the surgeon and author who helped found the coalition, approached Berman about coordinating an effort among the medical schools.”
To read more, please hit this link.

Gawande: Medicine needs ‘pit crews’

October 21, 2015by Robert Whitcomb in Uncategorized tagged , , , ,

 

pitcrew

 

Famed physician-writer Atul Gawande, M.D., says that patient outcomes depend just as much on well-coordinated teams as they do on technically skilled clinicians. Dr. Gawande is  a health-policy professor at the Harvard T.H. Chan School of Public Health and a staff writer for The New Yorker. He made his remarks at the recent Medical Group Management Association 2015 Annual Conference.

As example, Medscape reported,  “he described the case of Duane Smith, who was involved in a car accident and was left with broken limbs, a fractured pelvis, collapsed lungs, and a ruptured, hemorrhaging spleen, which had to be removed.

“Smith pulled through after a 3-week stay in an intensive care unit, but did not receive the three vaccines that would guard against streptococcus and other bacteria that the spleen normally clears.

“Two years later, during a beach vacation with his wife and daughter, Smith came down with an ordinary strep infection that his body was powerless to combat, and developed sepsis.

“‘He survived, but he lost all of his fingers, all of his toes, and his nose,”‘

“It’s not clear where the breakdown was. Some people thought the outpatient physicians would take care of it. Some people thought maybe the ICU would take care of it. The ICU thought maybe the surgeons would take care of it. But it didn’t happen,” Dr. Gawande said.

“We have trained, hired, and rewarded physicians for being cowboys, but it’s pit crews that we need for our patients. Teams of clinicians deliver far better results than autonomous specialists, each doing their own thing.”

 

 

Transformation in McAllen

May 25, 2015by Robert Whitcomb in Uncategorized tagged , ,

 

Six years ago, in The New Yorker, Atul Gawande, M.D., wrote a famous study of extreme  healthcare cost and waste in impoverished McAllen, Texas. He recently returned to the Rio Grande Valley community and found huge changes, which came about, we should note, to a large extent because of his writing.

On his recent return, Dr. Gwande found:

Inpatient visits down 10 percent; home healthcare spending  down 40 percent; ambulance rides down 40 percent, and cost per beneficiary down almost $3,000, resulting in nearly half a billion dollars saved in the area.

The five big lessons he saw, as described by  Kavita Patel, M.D., managing director  for clinical transformation at the Brookings Institution’s Center for Health Policy, and Frank McStay, a research assistant, Economic Studies, at the Center for Health Policy as reported in MedPage Today. (Their remarks originated as a Brookings Web site post.)

“Evidence is hard to ignore, especially if it is out in the open.”

“Physicians  do not have all the right information.”

“Local clinical leadership and clinical knowledge are important in promoting health.”

“More evidence shows payment and delivery reforms may be working.”

“The biggest opportunities for cost reductions are with complicated patients.”

 

 

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