It was a great read, but nothing shocking – much of it reminded me of sections of Gawande’s 2008 book, Better – and it clocked in at a mammoth 12,000 words. Yet, even in the age of bullet points and boldface, that didn’t stop anyone. Why?
Putting aside the fact that Gawande’s a wonderful writer who’s built a powerful brand for himself, Yong instead considered the power of Gawande’s narrative structure. It’s something I’ve noticed throughout the man’s work, and something that he can get away with as a prominent surgeon who writes for magazines: He saves the climax of his key anecdote (the patient’s outcome) for the end, and usually weaves it into several minor peaks and valleys in the course of the story.
These four sections are all obviously united by a common theme. But to hang together in a single feature, they need more than that. Gawande achieves this by using the tale of a terminally ill cancer patient, Sara Monopoli, to frame the four topics. It is obvious enough to use real-life stories to illustrate the theme of death and Gawande’s experience gives him plenty to draw from. But his critical move was to use a single story to frame all of the others.
To Schmidt, the challenge of creating a system that synthesizes patient history and creates a list of standardized recommendations boils down to a simple “platform database problem,” something he says computer scientists are very good at.
Gawande‘s take is that programmers don’t quite understand the vagaries of a typical clinical encounter. The technological capability may exist, but it’s going to be hard to make an information system that is able to generate recommendations brief and practical enough to be of use to a typical super-busy physician who has to suss out six different problems in one 15-minute visit.
In the course of the discussion, Gawande and the council also bemoaned the relatively low status of the health systems analyst and brainstormed ways to raise the profile and effectiveness of the specialization.
After Gawande explained the situation through analogy and observation, he called for further research into the “positive deviants,” the cities and institutions offering the best care for the lowest cost. He gave examples of methods to avoid the unnecessary treatment he blames for high health care costs and finished by urging graduates to enter the workforce and fight for the soul of American medicine.