Book Club: Better

A couple of weeks ago, I wrote about the Annual Meeting of the Donoughue Foundation. The keynote speaker at the event was Atul Gawande, a general surgeon, writer for the New Yorker and author of two books, Complications and Better. Gawande spoke about the small things that can be done to make the healthcare system function significantly better. So, I satisfied my curiosity and picked up Better.

Before I reflect on one of the key ideas Gawande presents, let me tell you: this book is incredibly readable, engaging, and insightful. The essays are discrete, but they build on one another. It is a book that can sustain a straight read-through. Or, you can read it episodically – jumping around from an essay at the beginning to one at the end or putting the book down for other endeavors in between essays. No matter your approach, you will be rewarded for your effort.

In many of the essays, Gawande argues that great strides in healthcare can be made by concentrating on how healthcare is delivered, rather than on a race to new technologies of care. In his essay “Casualties of War,” Gawande looks at the vast reduction in fatalities in the Afghanistan and Iraq wars, compared to previous wars. He attributes this success to the attention to data collection and analysis. By tracking the kinds of injuries, the medical responses, and the outcomes, military medical personnel have been able to recommend preventive measures and improve the medical response system. Simple steps. Things like making sure soldiers wear their bulletproof vests or moving the medical team together with soldiers so that response times are cut substantially. These interventions were possible only because the medical staff tracked patterns of injury and analyzed their results.

In another essay, “The Bell Curve,” Gawande reports on the efforts of an organization called the Institute for Healthcare Improvement to improve medical practice by doing, in Gawande’s words, “two things: measure ourselves and be more open about what we are doing”. One outcome of this openness involves patient participation in improving the delivery of healthcare.

Connecticut could learn from the lessons of these essays. Many of the data that could be helpful for those of us who are trying to make our healthcare system more accessible, effective, and affordable are locked in individual companies (hospitals, doctors’ practices, insurance companies) and in our state agencies (where, even with FOI, the information may or may not be in a useful format). More systematic data collection and greater openness with that information is a necessary – though not sufficient – precondition to improving our healthcare system.
Connie Razza