How do we heal medicine? | Atul Gawande

[@AngelCruz56970]

Dr. Gawande mentioned a lot of great points throughout his talk here. He hit on topics of cost of care and the complexity of medicine as it is now. One thing I really liked about his talk was he talked about the most expensive care for patients isn’t always the best care for them. I believe this to be true on most occasions and it varies in a case-by-case situation. I think some doctors don’t take into consideration that thought of cost in some of their patients’ care and that aspect is crucial for a lot patients that are hesitant in seeking out medical attention. He mentions how we must bring the components of medicine into a whole and make it work succinctly. This brought a lot of perspective for me in that, even as patients we focus on wanting the best, but it may not always work when those “best” pieces are put together for our health. The idea that Dr. Gawande implemented in with the checklist seemed odd to me at first, but seeing and understanding how crucial it can be to lowering death rates was really interesting. Something as simple as a checklist can make a huge difference for patient’s care. It’s changing the perspective that doctors have of having that self-sufficiency and independence. It is a unique aspect that Dr. Gawande mentioned of adapting a different mind set that can help heal medicine. Overall, this brings a lot of perspective as a patient and a medical student that will be treating patients in the future.

[@MedicalStudentfor]

I first heard of Dr. Gawande during my first year of medical school in my ethics class. During this class we were introduced to Dr. Gawande and his book “Being Mortal.” I was so captivated by Dr. Gawande and his perspective on mortality in medicine. Dr. Gawande makes some amazing points on our current healthcare model. Dr. Gawande commented on the arrogance of physicians and the need for humility. Even the most specialized of physicians are not immune to making mistakes. If we can accept that physicians are not inherently perfect, we can understand the benefits of using a checklist. One principle of medical ethics is beneficence. I believe the use of checklist and interprofessional communication strategies like closed-loop communication can have a huge positive impact on patient care. The arrogance of some physicians to think they are above this is dangerous to all patients. Any policy that we put into place that increases the safety of patients should not be met with resistance, especially in the field of medicine. We have an obligation to try any and all strategies to help decrease the ever growing complexities of medicine.

[@KeebRocks]

"Just using a checklist requires you to embrace different values from ones we've had, like humility..." As a final year medical student I couldn't agree more with this. It pains me to say it, but doctors are too arrogant and surgeons tend to be even more so. In fact being a bit arrogant is seen as a positive trait by many in surgery.

[@fmundo2]

Atul Gawande has, with his work in education of physicians, has probably saved more lives than anyone else in medicine. And then there is his "must read" book "Being Mortal" which should be read by everyone who is over 60.

[@greysongan3410]

@the Being Mortal part Or just anyone. Ever.

[@greysongan3410]

@@sianisenthilkumar190 you must live in a pretty conservative social circle

[@letsgetethical-ur2tm]

Dr. Gawande makes a very interesting and critical point in his TED talk when he discusses the importance of “pit crews” in every professional field, but especially in medicine. While medicine has greatly advanced over the last several decades, there are still high numbers of those that receive incomplete or inappropriate care. His implementation of a checklist that resulted in a significant drop in surgical complications and post-surgical mortality really reminded me that despite how knowledgeable and advanced clinicians have become, the basics of teamwork can get overlooked and result in poor patient care and outcome. When it comes to medicine, especially the advancement of medicine, the ethical notion of beneficence, which is the notion of “doing good”, usually comes to my mind. Dr. Gawande’s successful checklist, however, really highlights the ethical notion of non-maleficence, which means to “do no harm or prevent harm.” By implementing this surgical checklist and making sure that everyone on the team was on the same page and that small details were checked off, it made sure that no further complications were made. It prevented incomplete/inappropriate care, or harm, from happening. As this video was made in 2012, I can only hope that Dr. Gawande’s checklist has been implemented and successfully utilized in many more hospitals and medical centers across both the U.S. and world.

[@kendallstainton4798]

This was a very awesome speech! I have also read Atul Gawande's book "Complications." I completely agree with it. We are too focused on doing too much, to where we make things way worse of a simple situation and stop listening to patients. So focused on this "cookbook method" where doctors are doing tests after test. Way too many cat-scans done, for issues it isn't even necessary for and just making it more expensive and more stressful for the patient. By this the patient-doctor relationship is damaged..not taking time to actually listen to the patients and listening to their symptoms inside of assuming and doing unnecessary procedures. This is a great study! To step a few steps back and focus on the basics and avoiding mistakes and even saving lives. To just go through a mental checklist and making sure everything is set. Also he is absolutely right, everything doesn't have to be this giant, grand thing, or drug. It is time again to just focus on the basics. I am surprised on how many lives this simple study has saved around the world and the crazy, ridiculous amount of cat-scans and probably MRI's have one done in one year.

[@Dudemon-1]

Bill Clinton paid medical schools to *NOT* train doctors because Hillary thought we had too many. So now we have too few physicians, and we're plugging the gap with nurse practitioners (which have 3-5% of the training if a physician). It's insane.

[@tarasierralee]

Brilliant, brilliant, brilliant! I've seen this before, but I have an entire new appreciation. I want Gawande to take on mainstream psychiatry and the corruption inherent in the "system" that benefits the oppressors at the expense of the oppressed. We need to do with psychiatry what he is attempting to do with surgery. HUMILITY, DISCIPLINE, TEAMWORK over INDEPENDENCE, SELF-SUFFICIENCY, AUTONOMY.

[@alliewallace1962]

Although this talk is over 10 years old, the meaning is timeless. I appreciate how Dr. Gawande discussed so many aspects of medicine, from cost to teamwork, it was fascinating to listen to him breakdown faults in the medical system. As a current medical student, this makes me consider how I can implement checklists in my future practice to ensure things don’t go unchecked. No matter the level of knowledge and experience we acquire, it is always important to make sure the small, but important, things don’t get overlooked. As many others can probably attest, arrogance is a problem for many physicians which clearly causes a problem. The resistance to utilizing a checklist is so frustrating to me. Even with multiple examples of greatly improved patient outcomes from all over the world, physicians were still hesitant to implement new strategies in their day-to-day practice. This isn’t about our independence as physicians, this is about beneficence and non-maleficence for our patients. As Dr. Gawande stated, enacting systems and reminding those in the medical field, physician or not, that we are a part of a team and in order for the complexities of medicine to function at their best, group success is a must. This reminded me of hand-off techniques we have learned that that remind us to have good and effective communication in order to have better outcomes and less confusion. As medicine becomes more complex, our communication skills will only become more important. If we, as medical professionals, continue to allow ourselves to confront our own humility, and function with discipline and as a team, I have no doubt our patient outcomes will become better and our medical system will be more effective.

[@adwilkin14]

I never thought of healthcare this way. I just always assumed that when I went to the doctor I was getting the best care I needed, not the best guess my doctor had. I understand that doctors are very knowledgeable and are more than likely right when suggesting tests to correctly diagnose. I don't expect them to be right 100% of the time but I do expect that if they don't know the answer to ask for help, not give it their best guess. This is what Gawande is talking about when he says hospitals need pit crews. We need an all-round knowledgeable staff that knows when to ask for help and not act upon what they think is correct. Doctors have become too focused on what they believe needs to be done rather than what is in the best interest of the patient. Performing a test that doesn’t need to be done can be costly and if the patient accepts the doctor's suggestion to do this test and it comes back negative the patient is then responsible for that cost. Gawande states that the most expensive care isn't always the best care. I have a friend who broke his back and the first doctor he went to said he needed surgery which was not only costly but had increased chances of complications during surgery. He went to a second doctor and this doctor offered him an alternative to surgery which was much cheaper and had less chance of surgical mishaps. The second doctor was focused more on the patient than on fixing the problem. Yes, both options would have fixed the problem but the second doctor had a more patient focused mindset. I like the idea of having a checklist that the surgeons went through for each portion of the surgery. I wouldn't have expected to see such a drastic drop in complication rates just by implementing a checklist but sometimes the little things get overlooked when performing the same activity over and over again. This is ensuring that the patient is getting the best care possible and that all parts of the pit crew are on the same page. I can't believe that they are struggling to put this in place with how impressive the results were. If each part of an office implemented a checklist to go over even just at the beginning of the day so that everyone is on the same page imagine the increased productivity.

[@amardeepkarodkar2]

One of the best Ted talk I have ever watched. Dr. Gawande is the master in medicine. He is trying to change the entire world of healthcare by doing genuine work. I am humble to you Mr. Atul Gawande. you are genius. Thank for making health care more efficient. I wish you all the best for your future work.

[@littlemas2]

Having a son with kidney failure, I will say that I have experienced both kinds of care. In one hospital people obviously did not talk to one another. At Mayo Clinic in Rochester, MN the care has been fantastic, and it is obvious that they work as a great team.

[@MARINALOVEDSK1]

I already see the future if I ever land a job managing a healthcare office or dept. This speech had me thinking about all kind idea's to implement if when and that happens. I learned a lot from this video.

[@ciararobb8049]

Humans are imperfect. They make mistakes and are inclined to have bad days due to personal, physical, emotional, or environmental things outside of their control. Relying on a group of humans to do everything right every time, simply by their memory alone is a recipe for mistakes. Using a checklist helps to eliminate human error. It is simply astonishing that death in surgery’s declined by 47% after the implementation of a surgical check list. I hope that during my career we will see checklists implemented across every specialty of medicine for every type of procedure to improve patient safety and reduce mistakes. Some physicians may see this as a burden or restrictive, but I would see it as freeing. It takes some of the weight off the health care teams shoulders, to remember everything every time and to never miss an important checkpoint for a patient. My husband is a pilot, and he loves checklists, they help him to remain safe and also help give him confidence he is not missing any crucial steps every single time he fly’s. I would argue it is unethical to be against the production of standardized evidence-based checklists for every aspect of medicine. Checklists promote patient safety, accountability, transparency, consistence, and professionalism. The only reasons why I could see a health care provider opposing well created evidence-based checklists would be a lack of humility or a unwillingness to accept health care is better when it works as a unified system. Health care is so specialized and disjointed and it causes so much heartache and confusion for patients. We need a change and we all need to work together to create safer, more efficient, and more patient centered systems.

[@varuviv]

Huge fan of Dr. Gawande. Simply brilliant!

[@jns124able]

Im happy to say...the focus in family medicine in Canada in on the patient, the patients fears, expectations, goals, function of living and preferences. How many doctors continue this I dont know, but it is in the curriculum.

[@MrMperis]

I am a spine surgeon and love the "Lifewings" program we have instituted at our hospital. All the surgeons and staff are on board and believe in it.

[@alanczak]

There is not doubt about it that the prices of healthcare is out of control. It is completely ridiculous that doctors, and patients are subject to this. In addition to this, Gawande makes a great point that in medicine, doctors cannot do it all. There are far to many aspects of the human body for one doctor to know everything. I was very surprised that the number of doctors to patients has increased so greatly in the past few decades. Going from 2 doctors per patient to 15. That just seems like an excessive amount, but it makes sense. As for checklists, I really do think that is a good idea. It makes sure things aren't missed, It can be so easy to miss something small, with that checklist you have an accountability factor. I like how he focuses on the important of team work. With so many doctors being specialized, the need for them to work together for one patient is essential. As for having pit-crew's for patient, I think that is a brilliant idea. What kind of patient doesn't want a team behind them assisting in all ways possible. Pit crew's don't even have to just nurses and one doctor. All doctors need to be on each other's pit crew so the can assist when needed. I think if doctors were willing to implement this pit crew idea health care would be forever changed in a positive light.

[@chloegallego3623]

are you saying there are 15 doctors per patient?

[@chloegallego3623]

ahh...not doctors, but clinicians, basically a team effort, makes sense. probably 1-3 doctors at a time generally depending on the severity...say brain cancer...you would need at least an nucluer medicine doctor (radiologist) a pathologist, general doctor, surgeon, anesthesiologist, and a hematologist if you are administering chemo. So that is 7? for a complex issue...

[@baileyschnell6276]

I very much agree with your stance on this topic as that not only is our healthcare prices beginning to rise but that our doctors need help to be able to address every patient in all aspects. It personally didn't surprise me that the doctor to patient ration has decreased majorly, since today our doctors always seem to be so busy and have a much larger amount to handle than they used to. Not only do doctors have a much tighter schedule, but many more patients to address every day. When speaker Gawande pointed out that medical professionals all need to work towards being a "pit-crew" for each patient I as well thought that was a smart plan, as that more knowledge coming from each perspective on a medical team would support the best possible outcome for the patient. Doctors are expected to be very knowledgeable yes, but the human body is so complex it's impossible for them to know every aspect, where as something wrong with a patient one doctor doesn't know, another one might. I also felt that the checklist for surgeons to follow to limit the death rate in surgeries is something that should be pursued, especially with the phenomenal statistics that the hospitals that adopted this method, the death rate fell 47%. This is huge especially when involving such an important topic, of death rates in surgery that are costing people their lives with simple mistakes. Overall I do agree, that these ideas could forever change healthcare in a positive way.

[@abdulomar5945]

Gg

[@justgivemethetruth]

Gawande is really great, read any of his books and they are so well expressed and reasoned, just fantastic and positive and life affirming.

[@scottlohndorf7758]

As a future physician I couldn't agree more with what Dr. Gawande is talking about. It is shocking to me that physicians are reluctant to implement these checklist changes. Doctors have an ethical and moral obligation to their patients and with data showing such a strong change in success rates it is difficult to comprehend the reluctance to change. I understand that people push against any change that may come about but as physicians we learn new things daily and are forced to adapt to new technologies and ideas. Autonomy as a physician should not trump the autonomy of the patient because they are trusting that you are doing what is best for them as a whole patient. I liked that Dr. Gawande spoke about the cost of healthcare and that the simplest and cost-effective solution is usually the best. As a future osteopathic physician we are taught that the body is capable of self-healing and this principle is key to reducing the amount of hospital stays and the overall cost to the patient. Thank you for your work, you are an inspiration.

[@bumblebeez1314]

I appreciate your thoughts here. I think something that sums up your comment on autonomy is the concept of altruism or the idea of selfless concern for the well-being of others. In order to act in accordance with the ethical principle of beneficence, the best interest of the patient has to be the primary reason we take any action in health care. I think when it comes to his checklist idea, its common that people are hesitant to change at the beginning, especially if they think what they have been doing is "working just fine". I think so many people on a surgery team are so focused on what their role is and what they are supposed to be doing for the patient that they often don't consider how all the parts work together. I think the checklists are a great reminder that everyone is there for the same patient at the same time and that what is best for the patient should always be at the forefront of whatever actions they are taking. I also like your thought on the osteopathic principle that the body is capable of self-healing is a way to reduce health care costs. Things we learn as osteopathic doctors are often a cost-effective way of helping the healing process and often times lead to better outcomes with less side effects than medications or procedures. I wonder what other little changes we could make that would also help decrease costs and complication rates? I believe that the most important thing we can do is to keep an open mind when it comes to ideas for change as we may not know how big of an impact it could make.

[@mpking-ey7ys]

His skills to solve a complex problem remind me of George Polya's How to Solve It (most mathematicians know about this). a. recognise/define a problem, b. devise a plan, c. implement it. Except Polya has another step, d. improve it.

[@veganath]

Couldn't have said it better myself, fortunately there is a growing number of people like us who get it... Thumbs up from me When pharmaceutical companies understand that a patient cured is customer lost, the medical system is inherently disingenuous.

[@medicalethics1234]

Dr. Gawande poses an interesting argument that the values of physicians need to change in order to promote the best care for their patients. His description of 1930’s physicians practicing with full autonomy and being involved in every aspect of a patient’s care highlights the importance of independence of the physician at that time. However, as technology has advanced far beyond the capability of any single person to know it all, the demand for physicians who can collaborate has become evident. Unfortunately, many physicians still approach medicine with the desire for full autonomy and resistance towards developing a systems-based approach to a patient’s medical care. Dr. Gawande further describes that his research has found that a systems-based approach confers superior patient care, potentially even when compared to additional training and improved technology. So why would our physicians be resistant to this change? This situation reminds me of the ethical principle of non-maleficence, a physician’s strongest obligation. For those unfamiliar with the term, non-maleficence is the ethical duty to not inflict harm or evil. While resisting adopting a systems-based approach to healthcare may not be an intentional cause of harm, it is evident that many patients are falling through the cracks in our healthcare system and are not receiving adequate care and thus harm is occurring, regardless of intention. Dr. Gawande poses a strong argument that the world of healthcare has drastically changed in the last 100 years through incredible advances in technology, and the values of today’s healthcare professionals need to change to accommodate this. There needs to be a shift from a healthcare professional valuing and acting with full autonomy to valuing and acting as a team player. Dr. Gawande’s research shows that this drastically improves patient care and outcomes, preventing unintentional harm to patients that often occurs otherwise through inadequate care caused by a lack of cohesiveness, and thus upholding the value of non-maleficence of the healthcare profession.

[@bcornels]

I have been in a nurse in surgery for three years and boy is this spot-on.

[@kathrynrivera8954]

Thank you 😷 for speaking up, Doctor.

[@Turritopsisify]

One of my favourite TEDtalks so far! More health care related ones would be brilliant.

[@gj-rw4gi]

14:05 checklist talk begins

[@FarReacher41]

Hospitals I have worked in in Canada have used checklists in some areas, like the OR and OBS case room for many years. Perhaps the first task of each and every area of a hospital, clinic, doctor's office etc. should be development of a checklist with the specific needs of that service.

[@kemchobhenchod]

the checklist manifesto is surprisingly empowering

[@Thatcrazydoc]

Personally, I already work in a hospital system filled with templates and checklists. In fact, the hospital that I work at has been visited by multiple members within congress due to our palliative and affordable care efforts to serve as a prototype for American healthcare.

[@Silascrane14]

Huge fan of Atul Gwande. This is exactly what I'm writing my term paper on.

[@wailinburnin]

Bravo, Checklists can be an essential part of "Quality Control". "Mission" and "Procedure" are the key elements of modern, professional, Project Management - managing unique endeavors of a limited duration. Project management represents the best efforts to evaluate what works in creating and maintaining effective organizations...And private health care without an underlying universal care system is immoral.

[@kalpanadashora09]

Excelente TED MED 2012, por Atul Gawande, propulsor del Surgical Check-list. video is motivating and show importance of checklists

[@MELANIE1001]

makes perfect sense, very good talk - surgeons need to realize it is a team effort, many that I have known tend to have that 'lone wolf' mentality, and this guy is right - that's not what is needed now. hopefully this can be implemented everywhere, or something like it.

[@LeonidasGGG]

Egos are the bigest problem in medical society nowadays.

[@armanigarrison7762]

so how do we differentiate between what's needed and what is necessary when it comes to expenses? because what i hear today is that some of the best treatments are some of the most expensive. is there a trade off that happens? like getting adequate care for something fast and easy? Or slow and more expensive for better care? is there a way for doctors to actually treat people while giving extraordinary care? or is that just the cards we are dealt?

[@Thatcrazydoc]

To be honest, the problem in the U.S. is not our standards. It's the fact that we cave in to the ridiculous demands of patients. I've seen it countless times where an Oncologist was going to give chemotherapy to a patient the same day they ended up dying, because the patient refused to acknowledge their illness.

[@BBig13]

“Doctors can’t know it all.” That statement explains why we have so many professions in healthcare from physical therapist to surgeon to nurse. With each of those professions comes a price for their services. Yes, medicine has become expensive. But it is easy to see why when you look at the price of the medicine itself, the doctor’s salary, the price of equipment, and the cost of the electricity and energy used in housing and taking care of a patient in a hospital. Adding more people to have more “pit crews” is only going to make the price of healthcare go up. In my opinion, doctors need to be more educated. They need more than just four years of medical school. If doctors were to learn more about the health profession they are going into, there would be less need for so many doctors for one patient. If this were the case, costs of healthcare could possibly be reduced.

[@bethany4262]

I think when he says "pit crews," he doesn't mean we should add more people. We already have professionals who collectively have that knowledge. Gawande was describing a system in which all these different parts can collaborate to make everything come together effectively for the patient. A lack of collaboration between different aspects of care leads to oversight and over treatment, even when you have the best people.

[@ratfoot]

I don't know if he knows it but he's spoken a lot about Lean concepts in these talks and his writing. New CEO of the Amazon Berkshire Chase Healthcare company they'll be huge

[@Thatcrazydoc]

Also, the sad part about this lecture is that people listening to it believe that we don't already have checklists and protocol. Every hospital in the U.S. already utilizes templates, checklists, and protocol to avoid infection and complications while encouraging an environment of patient safety. They already exist within a system.

[@alexrider9009]

Awesome speech! Very interesting and he speaks so enjoyable. I love it! :)

[@zeezsleep415]

Really interesting talk. And hopeful. If systems work everything can be seem more clearly. I have reacted away from the frustrations of bad and inefficient systems by doing things alone / and / or controlling them. That has been great. It allowed us to develop unusual products (Zeez Sleep Pebble) but it also its own disadvantages - loneliness, the inability to see beyond oneself. If we have crummy systems than no matter what excellence we introduce, the possibility for change is limited. The change that could be effected if systems worked - and change may be simple. Hopeful.

[@billjuss5331]

Good Medicine is NOT Politics, Its' about Patient Dr relationship, which leads to quicker, more accurate diag, and better pt outcomes. But you have to get to a Dr. First, NOT the nurse, NP, PA, Hospital Admin, conflicted Ins Co medical dir, or their nurses... The problem with using a pit stop crew concept applied to medical treatment again over simplifies medicine and complex diag and treatment options, its in theory is what happens with gov't and/or monopoly Ins company & hospital owned groups is goal is to treat more pt, not provide quality care -- resulting in repeated hospital stays, surgeries...

[@Amblix]

I am from the future - the year 2032. Robotics of all forms and applications has boomed as an industry and has reduced the cost of health care dramatically. On May of 2021, the President of the United States of America publicly praised Meditron Dynamics Inc. for driving this industry's exponential growth over the past 6 years. One of the boons of this dynamic growth was the reduction of health care costs across the board by 75%, over that period of 6 years!

[@TheLivirus]

Simple solution to a complex problem. Genious!

[@mya514]

Wow! incredible information he was truly right on target.

[@ostkartong]

In fact, I think his check list idea might even reduce costs due to lower frequency of infections, relapse, complications etc.

[@nellie6635]

the car parts engagingly is great, gets the point across understandably. so many people spend so much money on drugs that are proven to work but each persons chemicals and bodies are so different that there is no actual equation for success, and drugs are so expensive; trail and error is the only option with drugs unfortunately.

[@jbramson33]

you should watch the one by Abraham Verghese if you haven't already - very moving perspective on medicine, and the relationship of physician and patient.

[@reafdaw01]

You know it's ted when you're clapping at home.

[@MalluStyleMultiMedia]

Excellent speech

[@solomonkalit5119]

Brilliant mind

[@arduh]

I read his book Complications and came here. The book was amazing and this speech was too

[@OrthodoxAtheist]

Yep... some of our greatest minds and innovators just applauded a Harvard-educated doctor for instituting checklists. :| Rule 101... how did a system ever get designed without checklists (aka 'order'). :| Glad they finally caught up to the rest of the world.

[@martyyu]

In 2009, he wrote an exceptional article on health costs in the New Yorker. Just google his name and McAllen, Texas.

[@riddler251]

Awesome talk, but I am still confused by one thing. Why is there a random table of people sitting on stage behind the speaker? This was very distracting... and odd.

[@Thatcrazydoc]

Well, considering that the majority of physicians that I've encountered from other countries that come over here have never worked our hours at such a high level or been a part of the sheer complexity of a medical system such as ours (technology, medication variety, journey towards patient satisfaction), it would prove fatal to both patient's and our healthcare system alike.

[@Thatcrazydoc]

Totally agree. Personally, I believe that the fault is with the individuals within society and not the physicians. If you're coming back for your second CABG redo or your 14th admission to a hospital for the year because you love cocaine and you're not taking your diabetic meds or showing up for dialysis, then maybe the fault is yours and yours alone. The truth is that it happens everyday at every hospital in this country. That is what is driving up prices.

[@matthewjay660]

Dear igorkrupitsky, Thank-you for your courteous responses. I stated that the foreign M.D.'s need to stay in their own countries. I never stated that they must be "kept out". I embrace freedom, & if these foreign doctors want to leave their native countries, then that is their right. However, I repeat that it is my opinion that these M.D.'s should stay in their own countries so that they may heal the sick & injured of their own countries. I've never advocated using "force" in any of my comments.

[@arveycozza9820]

WTF you're saying dude? He was born, raised and did his MD in USA.

[@TheGerogero]

I think information about life expectancy in ancient times would come foremost from archaeological and historical studies, not medicine. I also spent a brief time reading on cow pox but I found no mention of India, so I don't understand what you mean.

[@g5realestate280]

Hope... he can change Healthcare in USA

[@sweetie1731]

Of course, the advancement of technology and treatment is going to increase the cost of healthcare. Doctors are being forced to know more now than ever which is why we have specialists. It is impossible to know everything. Doctors are performing more complex and dangerous procedures on patients. With risk comes a higher cost, unfortunately. The treatments with the least amount of risks are going to be the least expensive. Unfortunately, like he says, we always want the best. We tend to lean toward seeing the best doctors, and going through with the "best" treatments, no matter the price. Sometimes I think that specialists get so used to doing certain procedures that they begin to stop taking the little precautions. It becomes a habit to just assume everything is going to go well, because they have done it repeatedly. If they are forced to go through the checklist set up for them, I feel they will be more careful in going through the procedures. If we could get every hospital to follow the same procedural guidelines to a T, there would be much fewer deaths on the operating table, as well as after the operation. There are so many things that can go wrong once you open the human body up to outside air. Our skin is selectively-permeable for a reason. There are just some things in the air that should not be in our body. That is why we are built the way we are built; a system of filters, barriers, and systems that are meant to protect us. As soon as you open the body, you are putting it at risk. With a checklist, I think we can prevent surgeries from taking longer than necessary and therefore reducing the chances of infection. Also, it will force the specialists to follow specific protocols to keep them safe. This shouldn't just go for surgical procedures. Childbirth, physical therapy, any testing or treatment involving radiation, even things as simple as getting blood drawn, should have procedural checklists. If we can see positive results like saving lives from surgery, just think of what kind of results we could get from applying this to everything else. Perhaps, as the risks decreased, the cost of some of the procedures would too.

[@luluraeven]

Agreed- to the haters out there, educate yourself and open your eyes. The healthcare industry whether we like it or not IS a business and somebody somewhere stands to make a profit! I'm positive there have also been senators elected in exchange for funding or laws passed too. Where there is profit to be made, there is always corruption. The Hippocratic Oath only applies to a doctor, not the administrator or the 'system' or 'pitcrew' so to speak.

[@Siegames]

Thanks for the video

[@TheGerogero]

I can't tell what you're getting at. Personally I will always rely on tried and tested methods and of course I know they do not magically plop into existence. However, the treatment I was talking about is certainly irrevocably useless.

[@Utubebieber96]

YAAAAS! I read his book Being Mortal and ever since I was hooked!

[@hakankan7851]

I agree with doctor in the world

[@BizSustain]

The best care is often the least expensive.

[@funsukwangdoo]

you know it's ted when you get goosebumps...

[@docbybay]

Algorithms and checklists are his approach to making less errors and systematizing medicine so that it is applicable for the masses as a whole. I think it just means more guidelines, and homogenizing medicine to point where it is cookie cutter. Ex. diabetic patient not all of them need blood checks every 3 months in the clinic; some do... because of the severity of their disease I would not recommend all patients get HbA1c every 3 months, just because some check list tells me so. Medicine should be catered to the patient, each and every individual person; not one alogrithm One Algorithm to treat them all, One Algorithm to diagnosis them. One List to check them all and in wellness shall we find them.

[@ChibiZone]

You may have misinterpreted the message. With the evolving number of clinicians required per patient due to emerging drugs/medicines and medical or surgical procedures, it is impossible for a Single, Independent doctor to learn it all. This results in the creation of specialists. Specialists with the autonomous disposition. He's saying as specialists, the greatest problem is this disposition. We all need(regardless of occupation) to work as a pit crew. To communicate effectively, to be humble, disciplined, and have a team mentality. His system(I see this is a trigger word for you, but please bear with me.) isn't one to be applied to medicine or patients, it's to be applied to teams of physicians and surgeons. His system involves 3 skills: 1)Identifying the problem 2)Solving the problem 3)Implement or apply the solution This is essentially a system for doctors who are working Together to function better. Not a system applied to patients or those seeking health care. Please, listen with an open mind and do not form such subjective conclusions to these TED Talks.

[@mudassardesignspace]

If the doctors of Two generations back had thought exactly the way you thought of not fighting death till the last breath, I doubt we would have come where we are now...and this fight shall take us to more advanced medical treatment..we need to make constant efforts to excell..it will cost some painful lives now. but the medical treatment will get improved...what say ?

[@jane170]

what u was talk about is protocol by WHO & we do it in our hospital the problem is protocol has been st for a long time & not all hospitals around the world applying this !!

[@igorkrupitsky]

A simple way to cut US healthcare cost in half is to let doctors from countries with same or better standards practice medicine in US. Just give all of them work visas and medical licenses. However, this solution would not go well with US doctors.

[@TheaDragonSpirit]

I think the only way to heal medician is to actually heal cancer... and for the medical industry to actually do it's job rather than hand out pills. Which is what was said in this video, but I think the medical industry needs to look more at what people eat... and how this could affect people and there illness. They need to use food to heal people and they need to figure out how to heal cancer and use these methods in hospitals. IE: Gerson's Therapy. Something that actually works.

[@pkmkbindianarmy1480]

Indians are the best in medical science.

[@moustafadakroub4717]

akash barik eat curry

[@TheDeeeznuts]

I'm currently reading Complications: a surgeons notes on an imperfect science and its really good :-)

[@Amblix]

19:12 - the display updates to say "The Dinner Party". Maybe has something to do with that.

[@Casin01]

doctors forget that they are human sometimes.....and that we all can make mistakes

[@natedoggstyle]

This is a good talk but he conveniently avoids placing any blame of the cost on the suppliers (the hospitals, the doctors, and clinicians). It's an oligopoly essentially and supply is artificially controlled in order to keep the costs high. It has come to a head now where the high costs are warranting an examination but there is a shift of blame elsewhere to insurance and government. Nobody knows what the price of a procedure is and it "conveniently" changes depending on your ability to pay or not pay. This is covered by the book "An American Sickness: How Healthcare Became Big Business and How You Can Take It Back" by Elisabeth Rosenthal. Important read.

[@columbus8myhw]

He's talking about health globally, not just in the US.

[@amartya_chakraborty]

Great!!

[@econdemocracy]

Seven years ago(2012) Dr. Gawande said 35% (16:23) on average and they fell "in every hospital" but does that "average" decline give us an accurate picture of what to expect in the U.S. or other developed countries? Turns out after the 2009 pilot study there were follow-ups. Findings sharply more modest, like declines from 3.13% to 2.85% or 1.9% to 1.6% (I'm pasting below from TED website comment section by someone else, a comment other readers thought well of) Worth doing for such small declines? Of course. It's more like what's unsaid, that's too hot or "too" political for someone like AG to talk about, elephants in the room like the systemic things that separate U.S. healthcare (with generally same-or-lower outcomes for patients) from how national healthcare systems work in every. other. industrialized. country. For "making systems work" as he says he wants to do, you can't ignore the elephant in the room of what makes the U.S. "maximize short term profit for shareholders"-based healthcare as a commodity (which hurts both the poor and the wealthy who get unnecessary but profitable procedures etc) and makes ours in U.S. different from every other industrialized country's as not just the likes of PNHP but every (honest) analysis within the establishment as well (GAO, CBO etc) have shown over the decades. Anyway, on the narrower point of improvement rates, below is from the TED comment section by someone else, who cites all his sources (oh and, since our political duopoly is so dysfunctional and bought, I do actually wish Dr. Gawande well with the just-out press release he'll be heading the Berkshire Hathaway-Amazon-JP Morgan Chase healthcare project. A smallish island that's different, within the "maximize shorterm shareholder profit" system of healthcare in the U.S. could still make a difference, not enough, but better than nothing while we wait or work for actual national systemic change) Reuben Tang Posted 6 years ago The pilot study referred to by Gawande was preformed by Haynes, et al., 2009. A more careful consideration regarding the data provided by the earlier study finds that this decline in complications and mortality was not as great in hospitals in developed countries compared to hospitals in undeveloped countries (Ko, et al., 2012). Data collected by van Klei, et al., 2012, in a Dutch setting found that crude mortality ‘only’ decreased from 3.13% to 2.85% (P=0.19), while a study preformed by Sewell, et al., 2011, in the UK did not observe the same decline in complications and mortality as observed in Haynes, et al., 2009 (8.5% to 7.6% and 1.9% to 1.6% respectively). Barriers to effective checklist implementation stem not just from the above, as Fourcade, et al., 2012 identifies duplication with existing safety checks as the most commonly occuring barrier in implementing the checklist in 18 cancer centres in France. In a nutshell, based on current evidence, while the WHO surgical safety checklist is effective at decreasing complications and mortality, it is highly unlikely we will observe the same decrease in countries where protocol that perform a function similar to the checklist are already in place. Works cited Ko, H. C., Turner, T. J., & Finnigan, M. A. (2011). Systematic review of safety checklists for use by medical care teams in acute hospital settings--limited evidence of effectiveness. BMC Health Serv Res, 11, 211. Fourcade, A., Blache, J. L., Grenier, C., Bourgain, J. L., & Minvielle, E. (2012). Barriers to staff adoption of a surgical safety checklist. BMJ Qual Saf, 21(3), 191-197. Haynes, A. B., Weiser, T. G.,.. Gawande, A. A. (2009). A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. The New England Journal of Medicine, 360(5), 491-499. Sewell, M., Adebibe, M.,... Levack, B. (2011). Use of the WHO surgical safety checklist in trauma and orthopaedic patients. Int Orthop, 35(6), 897-901.

[@vonGleichenT]

Excellent!

[@platinummediauk]

I'm sorry but I would have hoped that these checklists already existed! Better late than never - reducing death rate by 47% percent! It's quite an obvious thing to have missed - did they not question the lack of preparation for surgical complications they encountered that caused deaths? There was a video a while ago about being honest about medical malpractice and reducing the shame associated with it - I suggested there should be a set of questions doctors and nurses should answer then - simple

[@tedoymisojos]

wow great talk

[@drbuddha4885]

Exceptional 💞

[@squamish4244]

The only thing I wonder about and wish he would address more is longevity research. Whether he likes it or not, eventually, in 30 years, 50 or 100, some people will be living very long lives in a state of eternal youth or whichever age they choose. Now, for some time, probably decades, it will be the rich. That is not a good recipe for social peace. Nevertheless, it will happen.

[@mrrobottony]

great talk!

[@Mikehoffmanart]

Who can trust a doctor who talks about illness and suffering without a single word about cause or prevention?

[@igorkrupitsky]

You must be the doctor I was talking about. :) I don’t blame you. I would probably hold the same position if I were you. Upton Sinclair once said: “It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" So basically you are implying that there is no country that has same or better standards than in US. Correct? As far as working hours at a high level, that is on of the problems my proposed solution is trying to address.

[@KnurdShogun]

i think it's crazy and upsetting that something so obvious as a checklist has not already been in application. wow.

[@Mikehoffmanart]

It's an admirable vision, but it's also profoundly incomplete. It never raises the question why there is such an epidemic of illness in the first place. Just as hospitals may need "pit crews" society may need a greater, overarching "pit crew" that can connect the dots and get Mankind back to a point where this health holocaust is transcended. I'd like to see a TED talk about that. I'd do it myself if they'd ask me.

[@veganath]

What is it about my comment ur responding too that refers to veganism? I can agree with u that advocating a non-violent society in which we don't cause unnecessary suffering to any living creature is desirable.

[@veganath]

I know what you mean, I'm fortunate enough to never have needed any doctor or pharmaceutical drug during the last 3 decades, health is soooo simple, eat your food as ALL other species of animals do "RAW" if it comes in a box it ain't food, if we can't eat our food RAW we probably have no business eating it

[@igorkrupitsky]

Dear Matthew, To be kept out of a country is the same as being forced not to enter a country. Without force people would enter and leave any country at will. States are similar to countries. You think it is ok to move and work between states because you were born in a country that allows it. It would be Red herrings if I offered something unrelated.

[@joshfultondotblogspo]

In China, you do pay for medical care, with your forced labor. It's not like they have a free society over there, and I'm willing to bet you that if you looked close at it there'd be a lot of horror stories, just like there are in Britain (which is now becoming more capitalistic.) And part of the reason natural supplements are not as popular, at least dollar-wise as pharmaceutical drugs, is #1 pharma drugs can do amazing things. This is not to denigrate natural supplements; I'm a huge fan.

[@swetshah92]

"knowledge has exploded..and has bought complexities and specialization"...

[@holdmybeer]

"im to good to make a mistake" mentality.

[@shpazshpaz]

great great video

[@ubersurgeon]

america has relatively lax rules for allowing foreign doctors to work. this is coming from a canadian doctor.

[@igorkrupitsky]

Dear Matthew, Following your logic we should also force doctors to stay in the states where born or received their education. It would be really evil to “outsource” a doctor from another state. We also want not want to “brain-drain” some states that have too many doctors.

[@Fusselwurmify]

Why does he remind me of Dr Bashir in DS9?