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That's not at all the case. http://atulgawande.com/about/ http://atulgawande.com/about/ Atul Gawande, MD, MPH, is a surgeon, writer, and public health researc

That's not at all the case. http://atulgawande.com/about/ http://atulgawande.com/about/ Atul Gawande, MD, MPH, is a surgeon, writer, and public health researcher. He practices general and endocrine surgery at Brigham and Women’s Hospital. He is Professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and the Samuel O. Thier Professor of Surgery at Harvard Medical School. He is also Executive Director of Ariadne Labs, a joint center for health systems innovation, and Chairman of Lifebox, a nonprofit organization making surgery safer globally. http://atulgawande.com/research/ http://atulgawande.com/research/ https://www.ncbi.nlm.nih.gov/pubmed/?term=Gawande%20AA%5BAuthor%5D&cauthor=true&cauthor_uid=29862506 https://www.ncbi.nlm.nih.gov/pubmed/?term=Gawande%20AA%5BAut...

arkades 8y ago
Oh, I know he’s a surgeon. He and I have very similar backgrounds, save that I spent a decade in hc QI and Health insurance mgmt before going to medical school, rather than picking it up subsequently. I point that out so you fully understand that when I say a doctor:healthcare QI as a bees:entomologist, I say that from both sides of the fence. It gives you some more insight in your little slice, but that’s it. And it’s just your little slice: I am not a surgeon, so I know jack shit about their operational processes. I do know from a recent kerfuffle in my hospital that even the surgeons don’t know much about how the OR department books rooms and schedules procedures. They certainly don’t have insight into the parts of the hospital that -aren’t- a core part of their job. Being a physician is an important window into how hc systems and organizations work, but it’s a tiny one. It doesn’t qualify one for hc QI by itself. As to his cv, by all means, check out where he’s first author, where he’s “contributing guy with a name” (second to last), how many of them are editorials or round tables, how many of them are endocrine surgery, etc. Actual first author, non editorial healthcare ops papers are thin on the ground. This feels like nitpicking. The guy is intelligent and accomplished, beyond question. But what he -isn’t- is a hc innovator just because he -writes- about the hc system and innovations therein. I’ve never seen him write on a topic that wasn’t already hot shit in the field for two decades; I’ve never seen him present the pile of conflicting data for his preferred solutions (eg, the Checklist Manifesto chose to elide how many hospitals implemented checklists to no improvement, despite plenty of the results being published before his book.)
leroy_masochist 8y ago
Fair enough, he's a popularizer and also a top-tier surgeon. I agree with parent comment -- there is a difference between being the person/people who came up with brilliant ideas and being the person who brought them to the masses in a pithy, cogent and engaging manner. One might even make the argument that the latter task is relatively more important than the former for people in high-visibility figurehead type positions such as CEO of a massively ambitious new healthcare venture. The "Gladwell for healthcare" comparison is a good one, and I say that as someone who has enjoyed reading Gawande's books.
- bookofjoe 8y ago
  >and also a top-tier surgeon. The only people who can differentiate between 1)surgeons who are expert in the O.R. whose patients do well in the long run and 2)those whose reputations exceed their abilities and results are anesthesiologists. Trust me, I was one for 38 years, at UCLA, the University of Virginia, and in private hospitals. I will never forget the time a world-renowned cardiac surgeon at UCLA at the height of his career — holder of an endowed distinguished chair, first author of the then most widely acclaimed textbook in the field, whose surgical skills were so sub-par he was only allowed to operate with a senior cardiac surgeon as his "first assistant" — was repairing a child's AV septal defect by sewing on a patch (on full cardiopulmonary bypass) only to be interrupted by his "first assistant" who quietly told him, "You've got the patch on backwards." I was standing literally two feet from the two of them, behind the drape.
  - prepend 8y ago
    So what’s your point? Should no one try to differentiate good surgeons or bad unless they are their peer for years? There’s lots of crappy programmers with good reputations too. But it’s a weird reply to “he’s a top tier surgeon” that you say it’s unknowable. I’m sure you’re right, I’m not a surgeon so I have no idea how to evaluate a good surgeon, but there must be some way to qualify the poor ones from the great ones. Your anecdote is a great example of high reputation, low skill. But is that the only instance. Is it 10%? Are most board certified, practice for 20 years surgeons good or bad? What’s the actionable intelligence, but it seems like the conversation ends with “it’s unknowable.” I am sort of aware of quality measurement, but not a healthcare practitioner, but I’ve noticed this comment from lots of docs that the only way to know if medicine is good or bad is to have a doctor review it.

arkades 8y ago

Oh, I know he’s a surgeon. He and I have very similar backgrounds, save that I spent a decade in hc QI and Health insurance mgmt before going to medical school, rather than picking it up subsequently. I point that out so you fully understand that when I say a doctor:healthcare QI as a bees:entomologist, I say that from both sides of the fence. It gives you some more insight in your little slice, but that’s it. And it’s just your little slice: I am not a surgeon, so I know jack shit about their operational processes. I do know from a recent kerfuffle in my hospital that even the surgeons don’t know much about how the OR department books rooms and schedules procedures. They certainly don’t have insight into the parts of the hospital that -aren’t- a core part of their job. Being a physician is an important window into how hc systems and organizations work, but it’s a tiny one. It doesn’t qualify one for hc QI by itself. As to his cv, by all means, check out where he’s first author, where he’s “contributing guy with a name” (second to last), how many of them are editorials or round tables, how many of them are endocrine surgery, etc. Actual first author, non editorial healthcare ops papers are thin on the ground. This feels like nitpicking. The guy is intelligent and accomplished, beyond question. But what he -isn’t- is a hc innovator just because he -writes- about the hc system and innovations therein. I’ve never seen him write on a topic that wasn’t already hot shit in the field for two decades; I’ve never seen him present the pile of conflicting data for his preferred solutions (eg, the Checklist Manifesto chose to elide how many hospitals implemented checklists to no improvement, despite plenty of the results being published before his book.)

leroy_masochist 8y ago

Fair enough, he's a popularizer and also a top-tier surgeon. I agree with parent comment -- there is a difference between being the person/people who came up with brilliant ideas and being the person who brought them to the masses in a pithy, cogent and engaging manner. One might even make the argument that the latter task is relatively more important than the former for people in high-visibility figurehead type positions such as CEO of a massively ambitious new healthcare venture. The "Gladwell for healthcare" comparison is a good one, and I say that as someone who has enjoyed reading Gawande's books.

bookofjoe 8y ago
>and also a top-tier surgeon. The only people who can differentiate between 1)surgeons who are expert in the O.R. whose patients do well in the long run and 2)those whose reputations exceed their abilities and results are anesthesiologists. Trust me, I was one for 38 years, at UCLA, the University of Virginia, and in private hospitals. I will never forget the time a world-renowned cardiac surgeon at UCLA at the height of his career — holder of an endowed distinguished chair, first author of the then most widely acclaimed textbook in the field, whose surgical skills were so sub-par he was only allowed to operate with a senior cardiac surgeon as his "first assistant" — was repairing a child's AV septal defect by sewing on a patch (on full cardiopulmonary bypass) only to be interrupted by his "first assistant" who quietly told him, "You've got the patch on backwards." I was standing literally two feet from the two of them, behind the drape.
- prepend 8y ago
  So what’s your point? Should no one try to differentiate good surgeons or bad unless they are their peer for years? There’s lots of crappy programmers with good reputations too. But it’s a weird reply to “he’s a top tier surgeon” that you say it’s unknowable. I’m sure you’re right, I’m not a surgeon so I have no idea how to evaluate a good surgeon, but there must be some way to qualify the poor ones from the great ones. Your anecdote is a great example of high reputation, low skill. But is that the only instance. Is it 10%? Are most board certified, practice for 20 years surgeons good or bad? What’s the actionable intelligence, but it seems like the conversation ends with “it’s unknowable.” I am sort of aware of quality measurement, but not a healthcare practitioner, but I’ve noticed this comment from lots of docs that the only way to know if medicine is good or bad is to have a doctor review it.