Gawande: Improve Quality of Care without Bankrupting the Country


Reforming the healthcare system in the United States is about much more than providing basic coverage for all its citizens.

Reforming the healthcare system in the United States is about much more than providing basic coverage for all its citizens. Such reform is also about how we deal with the issues of quality, safety, and cost. The challenge in the coming months is to balance all of these issues in a cost-efficient manner. So said Atul Gawande, MD, in the keynote address here at the American Association of Clinical Endocrinologists 19th Annual Meeting and Clinical Congress.

Gawande, associate professor of medicine at Harvard Medical School, is on staff at the Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts. He told AACE delegates that integrating health reform and systems change with the day-to-day care of patients can be difficult.

An endocrine surgeon who served as a senior health policy advisor in the Clinton presidential campaign and White House from 1992 to 1993, Dr. Gawande is also a staff writer for the New Yorker magazine and serves as Director of the World Health Organization’s Global Challenge for Safer Surgical Care.

In the battle over healthcare reform and health insurance that the country has recently been through, the deepest struggle lies not with insurance hassles or problems with government bureaucracy or with malpractice lawsuits that are often unnecessary and frivolous, but rather in the complexity of our healthcare system. “Complexity is the reason healthcare is often failing to work, failing to assure value, failing to be affordable, and also failing to seem fixable to people,” Gawande said.

Currently there are more than 13,600 diagnoses that can be made, with more than 6,000 drugs that doctors can prescribe, and more than 4,000 medical and surgical procedures that they can perform, he noted.

“Doctors have to provide these to everyone, with kindness and humanity, and with an extraordinary effort to make the right care arrive in the right way at the right time, without harm and without waste of resources. And guess what? It’s incredibly hard. There is no industry anywhere in the world that has to provide 13,600 different service lines in every community in the country, let alone the world, and customize it to every individual and hospital.”

Gawande said that the doubts that have been raised as to whether the U.S. can even attempt to solve the problems of its healthcare system as a nation are distressing. However, improving the system in a cost-efficient manner is the fundamental issue of the 21st century.

“We are going to need to figure these questions out if the country is to prosper as a whole,” he concluded. “It is hard to envision the step by step of it all, we have no off the shelf solutions, but one thing we do know is that all medicine is local, and our goal is to work in our own communities to make strong local systems that actually can produce the results we need.”

He concluded: The work of solving the problems of cost in our system is really the work of making great care. If we are able to make forward steps on our safety and our quality we will be doing the work that our country needs.”

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