Atul Gawande, MD, a cancer surgeon at Boston-based Brigham and Women's Hospital and contributor to The New Yorker, recently sat down with Tyler Cowen, PhD, an economics professor at Fairfax, Va.-based George Mason University, to discuss the role of technology in healthcare and his surgical career.
In his guest appearance on the podcast "Conversations with Tyler," Dr. Gawande offered his thoughts on a variety of subjects related to healthcare, technology and his personal journey with medicine.
Here are six insights from Dr. Gawande.
1. On using artificial intelligence to diagnosis patients: "[U.S. Healthcare] is massively far [from using AI in the diagnosis process] … people imagine [the diagnosis process as] people [coming] to you with a crisply defined problem. … The reality is, first of all, people come to you often unable to explain what their problem is. … The second part of [the process] is that it changes over time, and you're adding data along the way. You're integrating it with a little bit about your view of the understanding of the person and their likelihood to even say that something is a major symptom or not. There is no question that you can augment the human capability. But the idea that you pull out your phone and it would give you the diagnosis — it is still one of the hardest problems in reducing error in medicine, is the fact that we still have a high rate of error, and the sources of the error have to do with the human being rather than the calculation."
2. On the "danger" of gene editing CRISPR technology: "The danger to me isn't CRISPR, the danger is the larger culture that it goes into … The CRISPR capability is just another bullet in the holster that can be fired, but we are narrowing that neurotypical range in lots and lots of different directions, whether it's how we employ people, what kinds of options we put out there for people to have their aberrant thinking recognized and taken advantage of, to the ways we medicate and control people. And I think CRISPR — it actually will be exceedingly difficult to be able to pick many of these capabilities out, in part because they're multigene. These are not conditions that very often have to do with point mutations that you just adjust. They are interactions among many genes of a network."
3. On wearable technology: "What the problem is, is that the wearables have not been able to be integrated into the practice of medicine in a really critical way. Right now, the way a wearable is used, whether it's for tracking cardiac events or your mental state or other things like that, is that then it says, 'Notify your doctor.' Or it's a dump of a ton of data that a clinician is supposed to use and know how to integrate into practice. It hasn't been able to be used in such a way they're actually demonstrating major improvements in people's outcomes. However, we are entering this phase where we are now starting to be able to track — take your genomic data, take your laboratory data, take your imaging scans you've done — [and] couple it with information from wearables, like how you're doing over time [or] whether you're getting the medications you should be getting."
4. On what's "missing" in medical education: "[The medical profession is] no longer an individual craft of being the smartest, most experienced and capable individual. It's a profession that has exceeded the capabilities of any individual to manage the volume of knowledge and skill required. So we are now delivering as groups of people. And knowing how to be an effective group, how to solve problems when your group is not being effective, and to enable that capability — that, I think, is not being taught, it's not being researched. It is the biggest opportunity to advance human health, and we're not delivering on it. … The clinicians of the future, really need to be oriented in a counselor mode, where they are not just telling you what the options are, but also eliciting from you very clearly what your goals are, and then making a recommendation about what most matches your goals. … People have priorities besides mere survival."
5. On his flaws as a healthcare patient: "I don't go in [to see a physician,] hardly at all. … I've crossed 50 [years old], and I have never had to really be in the hospital or have a major event. But to the extent that the minor conditions I've had addressed, I invariably come way late in the game when the mild infection has become a much more significant one. And it's partly because I know too much about the ways in which healthcare really is pretty unreliable. … I think of ways in which I am good at being a patient is, once I'm in the door, I pick my team — I'm really careful about picking my team — and then I turn myself over to their process. I'm trying to pick them for their ability to run a process that seems appropriate. I think the interesting thing about doctors is that they do tend to not micromanage their doctors very much."
6. On his hiring process: "The secret to the hiring is actually, before you ever meet anybody, know what the heck you're trying to hire. The hardest part sometimes to get people to understand is, what is it you are asking them to do? In two years, give me the list, their score card. What are the five things that they will have accomplished? And then make sure you show it to them when they come in the door. And ask yourself as you are interviewing them, and then assessing who you're going to pick. Not 'Do I like this person?' or 'Would they be fun to be around?' or all of those kinds — those are factors. The ultimate question is, will they be successful in this list of things that you said would define their success in two years? And being again faithful … Maybe it is my focus talent. … We've got up to now 90 percent consistency in delivering on people who [are], as we call them, A-players. And most of it is in that front end, before they've even walked in the door, being clear about that step. And … talk to their references. That's the other real big mistake people make."
To read a transcript of Dr. Gawande's guest apperance on the podcast, click here.