Currently Reading: Being Mortal By Atul Gawande

atul-beingmortal-cover3d1-319x479.jpg (319×479)

I started this book Saturday with apprehension because of the subject matter. As I have read approximately 25% of the book, I must say the author does a tremendous job in sizing up American medicine. On the back cover of the book, Malcolm Gladwell sums it up very well.

“American medicine, Being Mortal reminds us, has prepared itself for life but not for death. This is Atul Gawande’s most powerful-and-moving book.”

Some really interesting paragraphs from the book, I wanted to share with our readers that I was unaware of:

From page 32:

“The idea that living things shut down instead of wearing down has received substantial support in recent years. Researchers working with the now famous worm C. elegans (twice in one decade, Nobel Prizes went to scientists doing work on the little nematode) were able, by altering a single gene, to produce worms that live more than twice as long and age more slowly. Scientists have since come up with single-gene alterations that increase the life spans of fruit, mice and yeast.”

From page 33 on inheritance:

“It turns out that inheritance has surprisingly little influence on longevity. James Vaupel, of the Max Planck Institute for Demographic Research, in Rostock, Germany, notes that only 3 percent of how long you’ll live, compared with the average, is explained by your parents’ longevity; by contrast, up to 90 percent of how tall you are is explained by your parents’ height. Even genetically identical twins vary widely in life span; the typical gap is more than fifteen years.”

That information was astounding to me!!!

From page 41:

“The job of any doctor, Bludau (the chief geriatrician at the Center for Older Adult Health at Brigham and Women’s Hospital in Boston, MA) later told me (Atul Gawande), is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible and the retention of enough function for active engagement in the world. Most doctors treat disease and figure that the rest will take care of itself. And if it doesn’t—if a patient is becoming infirm and heading toward a nursing home—well, that isn’t really a medical problem, is it?”

And finally from page 44:

“Several years ago, researchers at the University of Minnesota identified 568 men and women over the age of seventy who were living independently but were at high risk of becoming disabled because of chronic health problems, recent illness, or cognitive changes. With their permission, the researchers randomly assigned half of them to see a team of geriatric nurses and doctors—a team dedicated to the art and science of managing old age. The others were asked to see their usual physician, who was notified of their high-risk status. Within eighteen months, 10 percent of the patients in both groups had died. But the patients who had seen a geriatrics team were a quarter less likely to become disabled and half as likely to develop depression. They were 40 percent less likely to require home health services.”

I urge each of our readers to rush out and purchase a copy of this since it affects each and every one of us in some way. Here is a video from the author about the book:



Currently Reading: Finished Slow Ideas By Atul Gawande

Cover of "The Checklist Manifesto: How to...

Cover via Amazon

I began this article Slow Ideas: Some Innovations Spread Fast: How Do You Speed The Ones That Don’t,” by Atul Gawande back on July 25, 2013 and finished it last night. Some of the takeaways:

The example he uses between the difference in the acceptance of anesthesia vs. antisepsis was very thought-provoking for me because I had never considered the difference between a visible and immediate problem (pain) as compared to an invisible problem (germs). This article made me think of Tony Robbins and the advent of neurolinguistic programming and this thought: People move toward pleasure and away from pain. Anesthesia made life better for the patients and so did anesthesia. However, ridding the hospital of sepsis, did not make life better for the doctors. The author makes a perfect example of why some innovations spread faster than others and why some even though they are excellent do not take hold.

The second part of the article reminded me of the author’s book The Checklist Manifesto and helped me ponder: Are there checklists that I should consider putting together for some of the things that I need to move on daily?

An excellent article that I highly recommend!!!

The Swiftness Of Innovation

I am currently halfway through The New Yorker article by Atul Gawande entitled “Slow Ideas”. I love Dr. Gawande’s writing and he is best know for the book The Checklist Manifesto (which I highly recommend).

The beginnning of the article starts out with a bang as he asks the question: Why do some innovations spread so swiftly and others so slowly? He compares the spread of anesthesia and antisepsis. I was trying to think of other innovations that took off and others that died on the vine. The whole point of the article thus far is that people talking to people is the way standards and behavior changes.

Saul Steinberg's "View of the World from ...

Saul Steinberg’s “View of the World from Ninth Avenue” cover. (Photo credit: Wikipedia)

Books In My Pile

Panelist Economic Historian Niall Ferguson at ...

Panelist Economic Historian Niall Ferguson at “Special World Debate” (Photo credit: Wikipedia)

I have numerous (more than I can possibly read in the next year) books in my pile and thought I would mention three since they are moving (very slowly) to the top.

The first is Safe Patients, Smart Hospitals by Peter Provonost, M.D., and Eric Vohr.There are two books to read when it comes to checklists: this one and The Checklist Manifesto by Atul Gawande (highly recommended). In order to cut down on mistakes in any endeavor and to make maximum use of your time, a checklist seems the way to go (because of its simplicity.

The next book is one I purchased earlier in the year, Top Dog: The Science of Winning and Losing by Po Bronson and Ashley Merryman. Having been a teaching tennis professional in Alabama and Louisiana in a previous life, I am fascinated in the psychology of how to handle these types of situtations. In tennis, the two best psychologists that I spoke with were Jim Loehr and Chuck Kriese, the former tennis coach at Clemson University. I am hoping this book will give me some more insight in this area.

The last is Civilization by Niall Ferguson. I love these type of books in the same vein as Guns, Germs and Steel by Jared Diamond and other authors such as Ian Morris (Why The West Runs For Now) and Francis Fukuyama (The Origins of Political Order). This book seems to have broad ideas and makes you consider how the major events in history and society have such cumulative effects on different aspects of our lives.

Notes From The Annals Of Health Care: Big Med By Atul Gawande Part Two

One of the interesting things that Dr. Gawande said in the article was that the standards covered the basics. When I taught tennis we really focused on the fundamentals and always came back to them when we had problems. Strategy was important but if you could not do the basics, then it was all for naught. What industries are currently in the forefront of moving ahead such as medicine is with the tele-I.C.U.? Currently, there are over two-hundred fifty hospitals from Alaska to Virginia that have installed a version of the tele-I.C.U..

This part of the article was interesting from the standpoint of who is really in charge in a hospital? Would it be the doctor who is physically at the location or the tele-present physican? I could tell by the article that there was an uneasiness about this.

Other interesting areas to contemplate in the article were computer forecasting of patient volume. What will this do to help drive down costs? And finally, will this move to big medicine suppress innovation and do the opposite of what is intended and drive up costs over time?

The Bon Mot Book Club - Dr. Atul Gawande

The Bon Mot Book Club – Dr. Atul Gawande (Photo credit: Urban Mixer)

Notes From Annals Of Health Care: Big Med By Atul Gawande Part One

Cover of "The Checklist Manifesto: How to...

Cover via Amazon

I am currently reading this article from the New Yorker Magazine and I actually have more questions after reading the article than before I read it. I understand Dr. Gawande’s premise that we need more of a need for checklists in performing medical services than freelancing (I meant this in a nice way!).

In the article it speaks of the Cheesecake Factory knowing its customers, will big medicine truly know its patients? Why are costs truly soaring in medicine? Why is the service mediocre at best with a poor level of quality? How does a hospital determine the rates of failure and complications? According to Nassim Nicholas Taleb, restaurants would be considered antifragile institutions. Would I describe our healthcare system in the same manner? Antifragile institutions learn from failure in that restaurants, as an antifragile institution, have to stay strong in costs, service and quality to continue improvement. How do they manage improvement? Should doctors be paid for results instead of services? Are healthcare reforms on the right track? How many medical facilities have instruction checklists.? This reminds me to reread The Checklist Manifesto by Atul Gawande.

What is “tacit knowledge” and is it actually used in surgery? How do we correct in this day and age without being overbearing? How does a hospital rate its efficiency? Exactly what is “guest forecasting”? How do hospitals actually do in controlling costs? Profit vs. Nonprofit? How many tests are actually necessary for the patient? What businesses or services follow a coordinated plan of action? Is all this too idealistic? Where do you get ratings on hospitals?

“Customization should be five percent, not ninety-five percent of what we do.”

John Wright

Is standardization really superior in surgery?

Quote From Page 58

“In medicine, good ideas still take an appallingly long time to trickle down. Recently, the American Academy of Neurology and the American Headache Society released new guidelines for migraine-headache-treatment. They recommended treating severe migraine sufferers-who have more than six attacks a month-with preventive medications and listed several drugs that markedly reduce the occurrence of attacks. The authors noted, however, that previous guidelines going back more than a decade had recommended such remedies, and doctors were still not providing them to more than two-thirds of patients. One study examined how long it took several major discoveries, such as the finding that the uses of beta-blockers after a heart attack improves survival, to reach even half of Americans. The answer was, on average, more than fifteen years.”

When someone is taught to someone how is the best way to assess the progress? How is the best way to disseminate innovation? Need to reread Where Good Ideas Come From by Steven Berlin Johnson.

Quote From Page 60

“Although fewer than one in four thousand Americans are in intensive care at any given time, they account for four percent of national healthcare costs.”

My emphasis on this: Absolutely unbelievable!!!