Tag Archives: new yorker

Dissecting Gawande’s narrative structure

In a recent post, Not Exactly Rocket Science’s Ed Yong tried to break down Atul Gawande’s work and figure out why it can be so darn compelling. Yong and many thousands of others (myself included) were riveted by Gawande’s latest New Yorker piece, a treatise on palliative care.


Atul Gawande in action. Photo by Center for American Progress via Flickr.

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.

Gawande, Google and health systems analysis

Earlier this month, New Yorker writer and surgeon Atul Gawande brought his checklist gospel (video) to the President’s Council of Advisors on Science and Technology. Writing for AAAS’ science-policy blog ScienceInsider, Jeffrey Mervis chronicled the encounter, paying special attention to the observations of council member and Google CEO Eric Schmidt.

electronic medical recordsGoogle CEO Eric Schmidt. Photo by World Economic Forum via Flickr

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.

Profile: Gawande’s self doubt gives writing nuance

Harvard Magazine‘s Elizabeth Gudrais looks at Dr. Atul Gawande’s Obama-approved work at the New Yorker and explores how and why a Massachusetts endocrine surgeon has become one of the most influential writers in today’s health care reform debate. Gudrais follows his writing career from his start at Slate.com to The New Yorker and the now-infamous town of McAllen, Texas, and examines how Gawande’s own “neurotic self-doubt” has helped his work hit the all the right chords in a nation going through its own period of health care soul-searching.

In speech, Gawande asks new MDs to cut costs

In the wake of his much-discussed New Yorker piece about health care costs, Dr. Atul Gawande spoke to graduates of the University of Chicago Pritzker School of Medicine about their role in lowering the national cost of health care.

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.