Tuesday, August 7, 2012

What Can Doctors Learn From Restaurants?

Like my recent experience at the Olive Garden, Mr. Checklist, Atul Gawande, has dinner at the Cheesecake Factory, and comes away impressed. The chain has successfully commoditized haute cuisine, bringing affordable fine dining to the hoi polloi. He suggests in this week's New Yorker that the same approach can work in the delivery of health care:
Reinventing medical care could produce hundreds of innovations. Some may be as simple as giving patients greater e-mail and online support from their clinicians, which would enable timelier advice and reduce the need for emergency-room visits. Others might involve smartphone apps for coaching the chronically ill in the management of their disease, new methods for getting advice from specialists, sophisticated systems for tracking outcomes and costs, and instant delivery to medical teams of up-to-date care protocols. Innovations could take a system that requires sixty-three clinicians for a knee replacement and knock the number down by half or more. But most significant will be the changes that finally put people like John Wright and Armin Ernst in charge of making care coherent, coördinated, and affordable.
I had been toying with reading the Checklist book, but, after listening to his TED talk on the way to the gym this morning, I think I've learned enough.

Thankfully, we haven't had much interaction with the health care system over the last decade, but what little we have has left me unimpressed. My Honda dealer seems to know more about my car than my pediatrician does about my children, and there's something about that statement that gives me pause; to say nothing of the incomprehensible billing system that my health insurance provider employs.

A lot of the current presidential campaign seems to focus on health care reform. As someone who had to buy his own health insurance both two and a half years previously, and four months ago, I can say that nothing seems to have changed in the interim. Let's hope that the new exchanges spur more competition when they come online in 2014. But I wouldn't bet on it. I very much enjoyed the recent book on the Garfield assassination, not least for its grisly depiction of the state of medicine in the 1880s, when doctors recoiled at the idea of washing their hands and using clean instruments. I wonder if a hundred years hence, people will look back at our system, and its freewheeling drug use, 5 minute doctor visits and byzantine cost structure, with the same morbid fascination. I certainly hope so.

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